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Pulmonary sequestration associated with pulmonary actinomycosis: A case report and literature review
Yun Wang1, Guangfeng Ma1, Na-Na Rao1
1Respiratory Department of Guizhou Aerospace Hospital affiliated with Zunyi Medical University, Zunyi, China.
Rationale:
Pulmonary sequestration (PS), a rare pulmonary disease, arises from congenital pulmonary vascular dysplasia. Meanwhile, pulmonary actinomycosis is a purulent infection of lung lesions triggered by the inhalation of actinomycetes, which is also uncommon. Even rarer is the occurrence of pulmonary actinomycete infection secondary to PS. Herein, we present a case report of such a rare occurrence.
Patient Concerns:
The 21-year-old female patient had been erroneously diagnosed with pneumonia and tuberculosis, presenting symptoms of cough, sputum, and hemoptysis; however, the implemented anti-infection and antituberculosis treatments proved to be ineffective.
Diagnoses:
The diagnosis of the sequestration in the right lower lung was confirmed through an enhanced chest CT scan and a 3-dimensional reconstruction of the pulmonary vessels.
Interventions:
During the surgical video-assisted thoracoscopic resection of the right lower lobe lesion, it was discovered that the isolated lung tissue's blood supply vessel originated from the thoracic aorta. Additionally, the pathological examination revealed that the lung tissue of the right lower lobe lesion was infected with pulmonary actinomycetes.
Outcomes:
Following thorough evaluation, the patient received a final diagnosis of pulmonary actinomycete infection that occurred secondary to right lower lung sequestration. Consequently, they underwent treatment consisting of high-dose penicillin administered for a period of 6 months post-operation. Over the course of the subsequent 23-month follow-up, no recurrence of the infection or abnormal CT scan findings were observed.
Lessons:
Pulmonary sequestration bears clinical resemblance to pulmonary actinomycetes. In cases where recurrent episodes of pneumonia occur at the same location, and chest imaging indicates persistent lesions in the basal segment of the lower lobe near the spine, the possibility of PS should be considered. Prompt chest-enhanced CT and 3-dimensional reconstruction of pulmonary vessels are crucial for a definitive diagnosis. Imaging findings such as mass-like consolidation, cystic lesions, liquefactive necrosis, and pneumonia-like changes, coupled with typical air suspension signs and sulfur-like particles visible under tracheoscopy, suggest a potential pulmonary actinomycete infection. Timely biopsy is essential to confirm the diagnosis and prevent missed or incorrect diagnoses.
Insights
This case report details a rare instance of pulmonary actinomycete infection secondary to pulmonary sequestration. Early diagnosis via CT scans and prompt treatment are crucial for managing this uncommon condition.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Pulmonary sequestration (PS) is a rare congenital vascular dysplasia of the lung.
- Pulmonary actinomycosis is an uncommon lung infection caused by actinomycetes.
- Co-occurrence of pulmonary actinomycosis secondary to PS is exceedingly rare.
Purpose of the Study:
- To report a rare case of pulmonary actinomycete infection secondary to pulmonary sequestration.
- To highlight diagnostic challenges and effective management strategies for this rare condition.
Main Methods:
- A 21-year-old female with persistent cough, sputum, and hemoptysis, initially misdiagnosed.
- Diagnosis confirmed by enhanced chest CT and 3D pulmonary vessel reconstruction, revealing right lower lobe sequestration.
- Surgical resection and pathological examination identified pulmonary actinomycetes infection.
Main Results:
- Final diagnosis: pulmonary actinomycete infection secondary to right lower lung sequestration.
- Successful treatment with 6 months of high-dose penicillin post-surgery.
- No recurrence observed during a 23-month follow-up.
Conclusions:
- Pulmonary sequestration can mimic pulmonary actinomycosis, necessitating high suspicion for PS in recurrent pneumonia cases with persistent basal lung lesions.
- Enhanced chest CT and 3D vascular reconstruction are vital for accurate diagnosis.
- Characteristic imaging findings and biopsy are essential to confirm pulmonary actinomycosis and prevent misdiagnosis.
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