COMMON COUGH,UNCOMMON CAUSE. F. Millhouse 1 , L.J. Schultz 1 ; 1 Emory University, Atlanta, GA LEARNING OBJECTIVES: 1. Learn when to evaluate further young patients with``recurrent pneumonias.'' 2. Recognize the clinical presentation of pulmonary sequestration. 3. Learn the pathology and pathophysiology surrounding the formation of sequestration cysts. CASE INFORMATION: A 26-year-old male presented with the complaint of a 2 ± 3 week history of cough productive of approximately one cup of yellow green sputum per day. On the day prior to admission, he noted 1 ± 2 teaspoons of blood with each cough. Five years earlier with a similar presentation, he was noted to have a cavitary lesion on chest x-ray. He was treated with antibiotics for a presumed lung abscess and was asymptomatic until this admission. Vital signs on admission revealed a blood pressure of 137/76, heart rate of 137, respirations of 22, temperature of 38.4 degrees Celsius, and a pulse ox of 88%. On physical exam he was a young well-developed male in no apparent distress with dullness to percussion and tubular breath sounds at the right base. Chest x-ray showed an interval increase of the air-fluid level within a large right middle and lower lobe cystic lesion and a left mid lung infiltrate. The patient was admitted and started on antibiotics for pneumonia and presumed lung abscess. The patient was unable to tolerate a CT scan or bronchoscopy secondary to uncontrollable coughing and hemoptysis. With a high suspicion for pulmonary sequestration, an aorto-bronchial arteriogram was obtained that confirmed the diagnosis. It showed an aberrant vessel arising off the infradiaphragmatic aorta just above the level of the celiac artery supplying a right lower lobe sequestration. DISCUSSION: Pulmonary sequestration is defined as an area of nonfunctioning lung tissue that lacks normal communication with the tracheobronchial tree and derives its blood supply from systemic vessels. Pulmonary sequestration is divided into two types: intralobar and extralobar sequestration. The former usually presents in early adulthood. The clinical presentation may range from asymptomatic to chest pain, chronic cough or hemoptysis. Radiographic findings can include either consolidation with irregular margins, multicystic lesions, or cavitation. The diagnosis should be considered in young patients with recurrent or persistent pneumonias. The treatment is surgical removal of the sequestration via segmentectomy or lobectomy. SEVERE POSTURAL HYPOTENSION AS A DELAYED SEQUELA OF LIGHTNING INJURY. V. Mukerji1 1 , R. Nonneman 1 ; 1 Southern Illinois University, Springfield, Illinois LEARNING OBJECTIVES: 1) Review the acute and delayed injuries that may result from lightning strike. 2) Recognize postural hypotension as a possible delayed sequela of lightning injury. CASE INFORMATION: A 27-year-old woman was referred to us for increasing dizziness and palpitations. About 8 years ago while sitting indoors with her foot on the fireplace grill she was struck by lightning. She suffered a brief syncopal episode followed by severe lower extremity weakness and inability to walk. With physical therapy her weakness had almost cleared but she continued to experience increasing dizziness and palpitations. Her physical examination was unremarkable except for a resting heart rate of 110 beats per minute. The EKG and echocardiogram were normal. On tilt table testing the patient became dizzy and lightheaded as the blood pressure fell from 116 to 76/42 mm Hg and her heart rate rose from 94 to 150 beats per minute. Her symptoms cleared and the heart rate and blood pressure returned to normal as soon as the table was brought back to the horizontal position. The tilt table test was then repeated with both lower extremities wrapped with Ace bandage. This time there were only minor changes in her blood pressure and heart rate and the patient remained asymptomatic. Compression stockings were recommended for the patient with significant improvement in her symptoms.