Pulmonary Sequestration Presenting as Hemoptysis in a Previously Healthy Young Female

aorta, indicating extralobar sequestration (ELS) of the right lower lobe (Figs 1 and 2).She underwent successful transcatheter arterial embolization (TAE) of an anomalous artery arising from the right lateral wall of the aorta at the T12 level and supplying the right posteromedial ELS (Figs 3 and 4).Subsequently, she underwent right-sided video-assisted thoracoscopic surgery (VATS) and resection of the right lower lobe sequestrated segment under general anesthesia.The right lower lobe sequestration and lung adhesion to the diaphragm were identified.Wedge excision of the sequestrated segment was done, and the specimen was sent to histology.Intercostal tube removal was done after 2 days, and she had an uneventful recovery following surgery.Histology of the wedge resection showed two thick-walled blood vessels in the parenchyma, with a chronic inflammatory cell infiltrate in the vessel lumen containing numerous multinucleated giant cells, admixed with mucoid material.The surrounding lung parenchyma showed IntroductIonPulmonary sequestration is nonfunctional lung tissue that does not communicate with the tracheobronchial tree but receives arterial supply from an anomalous systemic artery and drains into various veins. 1 Most of the patients present in childhood or adolescence with recurrent pneumonia in a localized segment, chronic cough, and occasionally hemoptysis as well. 1 Here, we present a case of pulmonary sequestration from Sri Lanka, presented with massive hemoptysis in her adulthood without prior history of similar symptoms. case descrIptIonA 23-year-old lady, previously healthy and a nonsmoker, presented with an acute onset of cough associated with mild hemoptysis, treated as an acute viral illness initially.Within 24 hours, she developed an episode of massive hemoptysis requiring hospital admission, followed by a further episode of moderate hemoptysis.There was no history of fever, constitutional symptoms, or prior similar episodes or recurrent respiratory infections.No history suggestive of vasculitis, connective tissue disease, tuberculosis, leptospirosis, or other systemic or infectious etiologies.She was hemodynamically stable; saturation was 97% on room air, lung auscultation revealed vesicular breath sounds, and there was no calf tenderness.All the infectious screening was negative.Urine analysis showed no evidence of red blood cells.The chest radiograph was normal.Proteinase 3 (PR3) and myeloperoxidase (MPO) antibodies were negative.A contrast-enhanced computed tomography (CECT) chest showed ground-glass infiltration in the basal segments of the right middle and lower lobes.Subsegmental consolidation in the posterior basal segment of the right lower lobe supplied by a systemic arterial feeder from the lower thoracic 1-