Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3658-3663
Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3658
Relationship between intralobar pulmonary sequestration and type A aortic dissection: A case report
Yi-Jie Wang, Ying-Yi Chen, Gang-Hua Lin
Yi-Jie Wang, Department of Surgery, Tri Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Ying-Yi Chen, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Gang-Hua Lin, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Author contributions: Wang YJ, Chen YY and Lin GH designed and performed the research; Wang YJ and Lin GH analyzed the data and wrote the manuscript.
Informed consent statement: Informed written consent was obtained from the patient to publish this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang-Hua Lin, MD, Doctor, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei 114, Taiwan. a2015joy@gmail.com
Received: March 6, 2023
Peer-review started: March 6, 2023
First decision: March 24, 2023
Revised: March 26, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: May 26, 2023
Abstract
BACKGROUND

Pulmonary sequestrations often lead to serious complications such as infections, tuberculosis, fatal hemoptysis, cardiovascular problems, and even malignant degeneration, but it is rarely documented with medium and large vessel vasculitis, which is likely to result in acute aortic syndromes.

CASE SUMMARY

A 44-year-old man with a history of acute Stanford type A aortic dissection status post-reconstructive surgery five years ago. The contrast-enhanced computed tomography of the chest at that time had also revealed an intralobar pulmonary sequestration in the left lower lung region, and the angiography also presented perivascular changes with mild mural thickening and wall enhancement, which indicated mild vasculitis. The intralobar pulmonary sequestration in the left lower lung region was long-term unprocessed, which was probably associated with his intermittent chest tightness since no specific medical findings were detected but only positive sputum culture with mycobacterium avium-intracellular complex and Aspergillus. We performed uniportal video-assisted thoracoscopic surgery with wedge resection of the left lower lung. Hypervascularity over the parietal pleura, engorgement of the bronchus due to a moderate amount of mucus, and firm adhesion of the lesion to the thoracic aorta were histopathologically noticed.

CONCLUSION

We hypothesized that a long-term pulmonary sequestration-related bacterial or fungal infection can result in focal infectious aortitis gradually, which may threateningly aggravate the formation of aortic dissection.

Keywords: Intralobar pulmonary sequestration, Acute aortic dissection, Medium and large vessel vasculitis, Infection, Case report

Core Tip: We present a case of a 44-year-old man with history of acute Stanford type A aortic dissection status post reconstructive surgery five years ago. An intralobar pulmonary sequestration in the left lower lung region was also noticed accidently, but without further management at that time. Since symptoms of chest tightness bothered him in recent one year, he came to Thoracic surgery outpatient department where slowly growing of the lung lesion was noticed. Admission was suggested for resection of the left lower lung.