Concurrent Hemoptysis and Hemothorax: A Life-Threatening Presentation of Pulmonary Sequestration in Adulthood

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

British Journal of Surgery

Abstract

Introduction: Pulmonary sequestration is a rare congenital malformation characterized by nonfunctioning lung tissue with anomalous systemic blood supply. It typically presents in childhood with recurrent infections. However, it may also present in adulthood as a life-threatening haemorrhage due to rupture of high-pressure systemic arterial blood supply. Case Presentation: A 37-year-oldpreviouslyhealthymalepresented to the emergency department with acute hemoptysis and upper back pain following two days of worsening cough. Initial examination revealed an increasingly pale appearance, and decreased breath sounds over the left lower chest. Computed tomography demonstrated an intrapulmonary sequestration of the left lower lobe with an anomalous feeding vessel from the thoracic aorta showing active extravasation, resulting in both hemoptysis and a large left hemothorax. Emergency chest tube placement yielded two litres of blood. While in the emergency department, the patient developed hemodynamic instability with tachycardia and hypotension. Massive transfusion protocol was initiated, and the patient underwent emergent left thoracotomy in the operating room. Intraoperative findings confirmed significant haemorrhage from the anomalous systemic vessel, which was successfully controlled and divided. A left lower lobectomy was completed. The patient recovered well and was discharged on postoperative day six. Conclusions: This case illustrates a unique presentation of pulmonary sequestration with concurrent intrabronchial and pleural haemorrhage, demonstrating the potential for catastrophic bleeding from anomalous systemic vasculature. The successful outcome highlights the importance of prompt recognition and immediate surgical intervention in managing this life-threatening complication.

Volume

112

Issue

Suppl 10

First Page

x98

Last Page

x98

Comments

ASiT (Association of Surgeons in Training) Surgical Conference, March 7-9, 2025, Belfast UK

DOI

10.1093/bjs/znaf128.391

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