Rozhl Chir. 2023 Winter;102(1):23-27. doi: 10.33699/PIS.2023.102.1.23-27.
The article reports the case of a patient with bronchopulmonary sequestration complicated by destructive actinomycotic inflammation leading to life-threatening hemoptysis. It was an adult patient with the history of repeated right-sided pneumonia the cause of which had not been investigated in detail in the past. Only hemoptysis, which appeared as a complication, led to a closer investigation of the background of repeated right-sided pneumonia. CT scan of the chest revealed a lesion of the middle lobe of the right lung with anomalous vascularization - compatible with intralobar sequestration. Initially, conservative antibiotic treatment of pneumonia was provided at a local clinic. Embolization of the afferent vessels of the sequestrum was indicated due to persistent hemoptysis; this led to a reduction of its blood supply, proven by a follow-up CT examination of the chest. Clinically, the hemoptysis subsided. Three weeks later, the hemoptysis reocurred. The patient was acutely hospitalized at a specialized thoracic surgery department where shortly after admission, hemoptysis progressed to life-threatening hemoptea. Urgent middle lobectomy of the right lung was approached via thoracotomy to treat the source of bleeding. The case describes unrecognized bronchopulmonary sequestration as a possible cause of recurrent ipsilateral pneumonia in adulthood; additionally, it emphasizes the possible risks associated with a pathologically altered tissue microenvironment of pulmonary sequestration, and the need for surgical removal in all indicated cases.
这篇文章报道了一例支气管肺隔离症合并破坏性放线菌性炎症的病例，导致危及生命的咯血。这是一位成年患者，过去曾有反复右侧肺炎病史，但未详细调查其病因。只有咯血作为并发症出现，才促使人们更深入地调查反复右侧肺炎的背景。胸部 CT 扫描显示右肺中叶有病变，伴异常血管化——符合叶内隔离症。最初，在当地诊所给予肺炎的保守抗生素治疗。由于持续咯血，提示隔离症的供血动脉栓塞；这通过随后的胸部 CT 检查证实了其血液供应减少。临床症状上，咯血得到缓解。3 周后，咯血再次发生。患者因急性咯血被收入专门的胸外科，入院后不久，咯血进展为危及生命的大咯血。通过开胸手术进行右肺中叶切除术以治疗出血源。该病例描述了支气管肺隔离症作为成人同侧肺炎反复发作的潜在原因；此外，它强调了肺部隔离症病理性改变的组织微环境可能带来的风险，以及在所有指征明确的情况下都需要进行手术切除。
