Pulmonary sequestration with superimposed hydatid cyst
This patient had a long history of fever, chest pain and cough. CT scan was done 3 months earlier and the diagnosis of a cavitatory pneumonia was presumed. Bronchoscopy and pus culture were done which showed very high Echinococcus granulosus, raising the possibility of pulmonary hydatid.
The diagnosis of sequestration was not established until after 3 months when the patient came back with the same clinical picture. A new CT scan showed almost the exact finding as the previous images.
Considering the age of the patient and the persistence of consolidation over this period, one should also consider sequestration, and a careful look for a feeding artery should have been done. In this case, the feeding artery was arising from the celiac trunk, and the draining veins were toward the pulmonary veins, such scenario is typical for intralobar sequestration.
Intraoperatively, there was dense adhesions between the parietal and visceral pleura, destruction of parts of the right middle lobe with aberrant blood vessel entering the chest cavity through the tendinous part of the right hemidiaphragm. The pathology was resected.
Pathological exam of the resected lesion showed cystic lesion with white membranous structure in keeping with hydatid cyst.