case_images: PMC11813874_01
case_images: Imaging and laboratory testing of the patient. (A) Chest CT showing pulmonary consolidation (arrow) in the right lower lung upon admission. (B) The abdominal CT scan displays a large right-sided perirenal hematoma (arrow). (C) Six months later, the chest CT indicated complete resolution of right lung consolidation. (D) Perirenal hematoma disappeared six months after treatment. (E) Hemoglobin levels dropped to 68 g/L and serum creatinine rose to 103 micromol/L on January 4, 2021, although both parameters gradually normalized following treatment. (F) Urine red blood cell count, which had significantly increased on January 4, 2021, also returned to normal after treatment.
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case_images: PMC11813874_01_fimmu-16-1544263-g001.jpg
case_images: f1
case_images: An enhanced CT scan of the chest identified a large blood vessel that originated from the thoracic aorta and entered the lower lobe of the right lung, which we considered indicative of pulmonary sequestration alongside a mass in the lower lobe ( Figure 1A ). Six months later, imaging studies showed resolution of the subcapsular hematoma and normalization of hemoglobin levels ( Figure 1 ), although serum creatinine levels remained slightly elevated.
case_images: Histopathologic examination of the lung. (A) Histopathologic examination revealed extensive inflammatory infiltration, predominantly composed of lymphocytes and histiocytes interspersed within the connective tissue. Notably, the formation of granulomas (characterized by clusters of macrophages and the presence of multinucleated giant cells [blue arrow]), were indicative of granulomatosis with polyangiitis (H&E, 200x). (B) Advanced fibrotic changes with thick collagen deposits (white arrow) disrupted the normal tissue cytoarchitecture. Small, round spaces resembling blood vessels (black stars) suggested neovascularization amid the fibrotic tissue. Intense accumulation of lymphoplasmacytic cells (blue arrow) was observed around the small vessels (H&E, 200x).
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case_images: PMC11813874_01_fimmu-16-1544263-g002.jpg
case_images: f2
case_images: A CT-guided lung biopsy was performed, and the pathology report depicted multiple granulomas and multinucleated giant cell hyperplasia with inflammatory cell infiltration and focal necrosis in the blood vessel wall ( Figure 2 ).