CHEST Guidelines-A-21-Year-Old-Man-With-Unilateral-Chest-Pain,-Loba

A-21-Year-Old-Man-With-Unilateral-Chest-Pain,-Loba

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A 21-year-old man with glucose-6-phosphate dehydrogenase deficiency presented with sudden onset of non-traumatic left upper abdominal and flank pain, initially treated as a viral syndrome. However, he returned with worsening conditions, including shortness of breath and fever, leading to a diagnosis of community-acquired pneumonia and treatment with doxycycline. His symptoms persisted, and further imaging showed consolidation in the left lower lobe with a large pleural effusion. Upon hospital admission, thoracentesis indicated hemothorax.<br /><br />The case was later identified as extralobar bronchopulmonary sequestration (BPS) complicated by torsion. BPS is a congenital condition with a mass of nonfunctional lung tissue having abnormal blood supply, often from the thoracic aorta. Extralobar sequestration, the type identified in this patient, resides outside normal lung boundaries and is wrapped in its own pleura, commonly found in the left thoracic region near the posterior costodiaphragmatic sulcus.<br /><br />Symptoms of BPS usually result from pulmonary infections, but torsion of the sequestered lung tissue can cause severe pain due to obstruction and infarction. Imaging is crucial for diagnosis, through enhanced CT scans that can uncover feeding vessels. In this case, the earlier CT scan showed a cutoff of a feeding vessel, which was missed initially but led to the correct diagnosis after re-evaluation.<br /><br />The treatment for symptomatic BPS is surgical resection. The patient in question underwent an emergent thoracotomy that revealed necrosed lung tissue, which was removed along with its vascular pedicle. Post-surgery, the patient recovered without complications.<br /><br />This case emphasizes recognizing BPS, especially in cases with sudden severe visceral pain and atypical imaging findings, to ensure accurate diagnosis and treatment, often involving advanced imaging techniques and surgical intervention.

Keywords

glucose-6-phosphate dehydrogenase deficiency

extralobar bronchopulmonary sequestration

torsion

community-acquired pneumonia

pleural effusion

hemothorax

thoracotomy

necrosed lung tissue

congenital lung condition

surgical resection