Role of endovascular embolization in improving the quality of life in a patient suffering from complicated intralobar pulmonary sequestration – A case report

Abstract

Intralobar pulmonary sequestration is a rare congenital malformation characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply and lacking normal communication with tracheobronchial tree. Recurrent pneumonia and massive hemoptysis are life threatening complications associated with it. Delay in the diagnosis and management can be fatal. We report here a case of intralobar pulmonary sequestration in a 18 year old female who presented with recurrent severe episodes of pneumonia and hemoptysis forcing her to drop out of school. The diagnosis was confirmed by CECT Thorax and CT Angiography. The patient was managed by minimally invasive endovascular treatment in the form of feeding artery embolization. She made a full recovery with satisfactory outcome. On subsequent follow up, there was no recurrence of symptoms and she is doing well socially and academically. The aim of this case report is to show feasibility and safety of embolization as a less-invasive management option for adult pulmonary sequestration complicated with hemoptysis and LRTIs and emphasize the importance of such minimally invasive technique to enhance the quality of life in such patients.

Lung Sequestration in an Octogenarian Male

“…Embolization has also been performed in case of massive hemoptysis associated with pulmonary sequestration, as bleeding from these lesions may be fatal. 9,10,16 To summarize, contrast-enhanced chest CT scan suggested pulmonary sequestration in this elderly gentleman and diagnosis was confirmed by identifying the feeding vessel with angiography. As the lesion was benign and the patient had only minimal symptoms, no additional interventions were made.…”

“…7,8 Treatment in adults is controversial and depends mainly on symptoms, and may include percutaneous embolization of the feeding artery, thoracoscopic, or open surgery. [9][10][11][12] However, in many cases, no treatment is required, 13 especially in patients of advanced age. 14 Diagnosis of this disorder beyond the age of 60 years is extremely rare.…”

Successful Embolization of aberrant pulmonary artery before elective lobectomy in a 13 year old presented with Pulmonary sequestration complicated with bronchiectasis.

“…Even after repeat HRCT, the diagnosis of our patient did not extend beyond bronchiectasis until the angiogram was done at the time of embolization. A surgical intervention was warranted as a life saving measure and selective bronchial artery embolization was offered as an elective lobectomy (after pre-operative assessment of lung functions) would carry a better prognosis [10].…”

Transarterial embolization of intralobar pulmonary sequestration in a young adult with hemoptysis

“…Embolization was selected for our patient as it was the most non-invasive treatment method, and it would have reduced the risk of intra-operative hemorrhage in the event of treatment failure requiring surgical management. While the majority embolizations for sequestrations have been performed in the pediatric population (4,5,(16)(17)(18)(19)(20)(21), there is emerging evidence to support a potential role for this therapy in the young adult population. Successful embolization for definitive management of intralobar pulmonary sequestration has been described in a 31-year-old man with recurrent hemoptysis (6), in a 25-year-old man with hemoptysis 7, and a 23-year-old with recurrent pulmonary infections and hemoptysis (22).…”

“…Successful embolization for definitive management of intralobar pulmonary sequestration has been described in a 31-year-old man with recurrent hemoptysis (6), in a 25-year-old man with hemoptysis 7, and a 23-year-old with recurrent pulmonary infections and hemoptysis (22). Sequestration embolization with PVA has been used alone (5,18), and in combination with coils (6).…”