654 Celiac Artery-Supplied Pulmonary Sequestration Presenting with Tuberculosis: A Case Report

Abstract Pulmonary sequestration is a rare congenital lung anomaly, accounting for 0.15-6.4% of all congenital lung malformations. The celiac artery, a rare source of blood supply for pulmonary sequestration, is found in about 21% of instances. A 16-year-old male presented with recurrent hemoptysis, fever, weight loss, and night sweats. The patient had a significant family history of tuberculosis, as the patient’s mother and brother were undergoing anti-tuberculosis treatment for proven Koch’s bacillus in sputum, and his father has died 3 months ago due to massive hemoptysis resulting from a proven tuberculosis infection. Initial investigations, including chest X-ray and sputum culture, confirmed tuberculosis, and the patient was started on anti-TB treatment. Despite clinical improvement, hemoptysis persisted, prompting further evaluation. Bronchoscopy revealed significant bleeding, and a contrast-enhanced chest CT identified a wedge-shaped enhancement in the left lower lobe with an aberrant arterial supply from the celiac artery, consistent with intralobar pulmonary sequestration. Surgical management involved left thoracotomy, ligation of the aberrant artery, and resection of the extensively damaged lower lobe. Histopathology confirmed pulmonary sequestration with granulomatous lesions indicative of tuberculosis. Follow-up showed no recurrence. Pulmonary sequestration involves nonfunctioning lung tissue without communication with the bronchial tree, often supplied by aberrant blood vessels. Infections are common, with Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus being frequent pathogens. Tuberculosis is rarely reported in pulmonary sequestration, especially in celiac artery-supplied cases, which is also a rare occurrence. Tuberculosis colonizes sequestered lungs due to high oxygen-rich blood flow, complicating diagnosis. Surgical resection is the primary treatment for Pulmonary sequestration.