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[A case report of pulmonary sequestration (Pryce I) associated with infective endocarditis]
1Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
Abstract:
We experienced a case of pulmonary sequestration of Pryce type I associated with infective endocarditis (IE). A 19-old-man had prolonged high fever of 39 degrees C against antibiotic therapy. He was referred to our hospital because of the positive blood culture and abnormal echocardiographic findings, which were severe aortic regurgitation with vegetations clinging the aortic cusps. In addition, his chest X-ray film showed mass lesion behind the cardiac shadow, and continuous murmur was auscultated on this portion. The left pulmonary arteriography revealed no arterial distribution to the left lower lobe, while aortography showed an aberrant artery arising from the descending aorta entering into this lobe. One month after aortic valve replacement for IE, left lower lobectomy and amputation of the aberrant artery were performed successfully. Pathologically, inflammatory changes of the aortic valve and proliferations of intimal and medial wall of the aberrant artery were shown. However, alveo-bronchial structure of the resected lobe was normal. Diagnosis, complications and surgical management of pulmonary sequestration were discussed.
Insights
This case study details a rare instance of pulmonary sequestration, a congenital lung malformation, complicated by infective endocarditis in a young man. Successful surgical intervention involved aortic valve replacement and lung resection.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonology
Background:
- Pulmonary sequestration is a rare congenital lung malformation.
- Infective endocarditis (IE) is a serious infection of the heart valves.
Observation:
- A 19-year-old male presented with persistent fever and was diagnosed with severe aortic regurgitation and vegetations.
- Imaging revealed a mass lesion in the left lower lobe supplied by an aberrant artery from the descending aorta, consistent with Pryce type I pulmonary sequestration.
Findings:
- The patient underwent successful aortic valve replacement for IE.
- Subsequently, a left lower lobectomy and aberrant artery amputation were performed for the pulmonary sequestration.
- Pathological examination confirmed inflammatory changes in the aortic valve and the aberrant artery, with normal lung parenchyma.
Implications:
- This case highlights the importance of considering rare congenital anomalies in complex clinical presentations.
- It underscores the successful combined surgical management of infective endocarditis and pulmonary sequestration.
- The study contributes to understanding the diagnosis and surgical treatment of pulmonary sequestration, particularly when associated with cardiac complications.