Abstract
A 26-year-old man was referred to our hospital because of dull pain in the right hypochondrium. Chest radiograph showed a mass in the right lower lung field. A chest radiograph taken one year earlier had shown a faint patchy shadow at the right cardiophrenic angle. Chest CT-scan revealed a cystic mass on the thoracic side of the right diaphragm, with a feeder vessel branching out from the celiac artery. Abdominal angiography identified an abnormal artery branching from the celiac artery and entering the mass. During the venous phase, the blood from the tumor drained into the left atrium via the inferior pulmonary vein. With a diagnosis of pulmonary sequestration, the patient underwent a right lower lobectomy. The abnormal artery was palpable in the pulmonary ligament, and was resected using a stapler. The resected specimen revealed that the cystic mass consisted of an enlarged bronchial lumen of the sequestrated lung, lined with a layer of bronchial epithelium and filled with a large amount of blood clots. On intralobar pulmonary sequestration, rapid size increase due to intrabronchial hemorrhage can develop without any infectious symptoms, sometimes progressing to fatal hemothorax due to perforation. Hemorrhaging intrapulmonary sequestration should be taken into consideration for a patient with a rapidly enlarging cystic pulmonary mass.
