Halos and Hemoptysis: A Case of Intrapulmonary Sequestration Masquerading as a Pulmonary Aspergilloma

Bronchopulmonary sequestration (BPS) is a rare congenital malformation of the lung characterized by nonfunctional pulmonary tissue without communication to the tracheobronchial tree and with anomalous arterial supply. Intralobar sequestration (ILS), the more common form, typically presents in childhood or early adulthood.

We describe the case of an 84-year-old woman with a history of untreated rheumatoid arthritis, coronary artery disease, and remote smoking, who presented with recurrent hemoptysis over 6 months. Initial evaluation revealed lower lobe cystic changes with an internal solid component and diffuse ground-glass opacities on chest CT, raising suspicion for fungal etiology. Serial imaging demonstrated interval progression of the cystic lesion with an enlarging solid component. The patient was treated with empiric oral antifungal therapy, but persistent hemoptysis and radiographic changes prompted surgical consultation. A left lower lobe segmentectomy was performed for definitive management. Histopathology revealed abnormal pulmonary parenchyma with dilated airspaces, mucus-filled airways, and enlarged vessels, consistent with intralobar BPS. No fungal elements or microorganisms were identified. This case appears to represent the oldest reported age at diagnosis of ILS.

This case underscores the importance of maintaining a broad differential diagnosis for recurrent hemoptysis in elderly patients. While infection, malignancy, and autoimmune disease are common considerations, congenital anomalies such as ILS can rarely present late in life. Awareness of this possibility may help avoid diagnostic anchoring and guide appropriate multidisciplinary management.