Respiratory Department of Guizhou Aerospace Hospital affiliated with Zunyi Medical University, Zunyi, China.
Central Laboratory of Guizhou Aerospace Hospital affiliated with Zunyi Medical University, Zunyi, China.
Medicine (Baltimore). 2024 Oct 4;103(40):e39981. doi: 10.1097/MD.0000000000039981.
Pulmonary sequestration (PS), a rare pulmonary disease, arises from congenital pulmonary vascular dysplasia. Meanwhile, pulmonary actinomycosis is a purulent infection of lung lesions triggered by the inhalation of actinomycetes, which is also uncommon. Even rarer is the occurrence of pulmonary actinomycete infection secondary to PS. Herein, we present a case report of such a rare occurrence.
The 21-year-old female patient had been erroneously diagnosed with pneumonia and tuberculosis, presenting symptoms of cough, sputum, and hemoptysis; however, the implemented anti-infection and antituberculosis treatments proved to be ineffective.
The diagnosis of the sequestration in the right lower lung was confirmed through an enhanced chest CT scan and a 3-dimensional reconstruction of the pulmonary vessels.
During the surgical video-assisted thoracoscopic resection of the right lower lobe lesion, it was discovered that the isolated lung tissue's blood supply vessel originated from the thoracic aorta. Additionally, the pathological examination revealed that the lung tissue of the right lower lobe lesion was infected with pulmonary actinomycetes.
Following thorough evaluation, the patient received a final diagnosis of pulmonary actinomycete infection that occurred secondary to right lower lung sequestration. Consequently, they underwent treatment consisting of high-dose penicillin administered for a period of 6 months post-operation. Over the course of the subsequent 23-month follow-up, no recurrence of the infection or abnormal CT scan findings were observed.
Pulmonary sequestration bears clinical resemblance to pulmonary actinomycetes. In cases where recurrent episodes of pneumonia occur at the same location, and chest imaging indicates persistent lesions in the basal segment of the lower lobe near the spine, the possibility of PS should be considered. Prompt chest-enhanced CT and 3-dimensional reconstruction of pulmonary vessels are crucial for a definitive diagnosis. Imaging findings such as mass-like consolidation, cystic lesions, liquefactive necrosis, and pneumonia-like changes, coupled with typical air suspension signs and sulfur-like particles visible under tracheoscopy, suggest a potential pulmonary actinomycete infection. Timely biopsy is essential to confirm the diagnosis and prevent missed or incorrect diagnoses.
肺隔离症（PS）是一种罕见的肺部疾病，源于先天性肺血管发育不良。同时，肺放线菌病是一种由放线菌吸入引起的肺部病变化脓性感染，也不常见。更罕见的是 PS 继发肺放线菌感染。本文报道了一例罕见病例。
这位 21 岁女性患者曾被误诊为肺炎和肺结核，表现为咳嗽、咳痰和咯血，但抗感染和抗结核治疗无效。
增强胸部 CT 扫描和肺血管 3 维重建证实了右下肺隔离症的诊断。
在电视辅助胸腔镜下右下肺叶病变切除术中，发现孤立肺组织的供血血管起源于胸主动脉。此外，病理检查显示右下肺叶病变的肺组织感染了肺放线菌。
经过彻底评估，患者最终诊断为右下肺隔离症继发肺放线菌感染。因此，他们在术后接受了为期 6 个月的大剂量青霉素治疗。在随后的 23 个月随访中，未观察到感染复发或 CT 扫描异常。
肺隔离症在临床上与肺放线菌病相似。对于反复发生同一部位肺炎且胸部影像学检查提示脊柱附近下叶基底段持续性病变的患者，应考虑 PS 的可能性。及时进行胸部增强 CT 和肺血管 3 维重建对于明确诊断至关重要。影像学表现包括块状实变、囊性病变、液化性坏死和肺炎样改变，结合气管镜下典型的空气悬浮征和硫磺样颗粒，提示可能存在肺放线菌感染。及时活检对于明确诊断和防止漏诊或误诊至关重要。
