Diagnostic imaging of intralobar bronchopulmonary sequestration

Pulmonary Sequestration

The purpose of this study was to determine the prevalence of enlargement of the azygos system in the case of lung sequestration and its potential usefulness in the differential diagnosis of lower lobe opacities. Seven consecutive adult cases of pulmonary sequestrations were retrospectively enrolled; 4 sequestrations were proved surgically and all 7 angiographically. A group of 50 consecutive patients with a normal chest CT were used as controls. Another group consisted of 25 consecutive patients identified on the basis of an opacity in a posterobasal location on chest CT. For the 3 groups, the maximum diameter of the azygos and hemiazygos veins was measured, the level of measurement located between the upper poles of the kidneys and the confluence of inferior pulmonary veins into the left atrium. The diameter of the azygos veins (mean 10.4±5.1 mm) and of the hemiazygos veins (mean 7.1±3.0 mm) in the sequestration group was significantly larger than the diameter of the azygos and hemiazygos veins in the control group (mean 5.7±2.5 mm, and 3.4±2.4 mm, respectively), as well as in the study group (mean 5.9±2.6 mm and 3.3±2.6 mm, respectively). Our results suggest that enlargement of the azygos system in association with a posterobasal chest opacity, although nonspecific, may be a useful additional CT sign of sequestration.

Imaging of extralobar pulmonary sequestration in a patient with tetralogy of Fallot with pulmonary atresia, ventricular septal defect and multiple aorto-pulmonary collateral arteries with multidetector computed tomography

Complex pulmonary vascular blood supply is common in patients with tetralogy of Fallot with pulmonary atresia, major systemic to pulmonary collateral arteries and hypoplastic or deficient central pulmonary arteries. An extralobar lung sequestration, which has not been described previously in these patients, was imaged in a 6-week-old infant with multidetector computed tomography with sub-millimeter resolution. Arterial and venous vessels were analyzed using three-dimensional vascular exploration tools and results were confirmed with cardiac catheterization.

Systemic arterial supply to the lungs in adults: spiral CT findings

Systemic arterial supply to the lungs can be congenital or due to acquired disease. Congenital diseases encompass bronchopulmonary sequestration and congenital pulmonary venolobar syndrome, in which the involved lung parenchyma is supplied by the aberrant systemic arteries. An anomalous systemic artery can also supply an area of otherwise normal lung parenchyma. In acquired diseases, hypertrophied normal systemic arteries supply the lungs. Hypertrophied systemic arteries include the bronchial arteries, intercostal arteries, internal mammary arteries, inferior phrenic arteries, branches of the thyrocervical trunk, branches of the hepatic arteries, and branches of the abdominal aorta. Hypertrophy of normal systemic arteries is encountered in patients with bronchiectasis, pulmonary tuberculosis, other pulmonary infections, pulmonary thromboembolism, or chronic obstructive pulmonary disease. These systemic arteries are considered to supply the lungs by means of anastomoses between bronchial and pulmonary arteries within the lung parenchyma or transpleural systemic-pulmonary artery anastomoses. In most cases, the correct diagnosis and treatment plan can be determined by identification of the systemic arteries on computed tomographic scans.

Extralobar pulmonary sequestration presenting as an anterior mediastinal tumor in an adult

Extralobar pulmonary sequestration (EPS) is a rather uncommon congenital anomaly. Most patients are diagnosed in their early life or during the first decade because of the early appearance of symptoms, including feeding difficulty, cyanosis, and dyspnea, or because of symptoms arising from the associated congenital abnormalities. Extralobar pulmonary sequestration is more often found between the lower lobe and the diaphragm and is usually associated with other congenital abnormalities, but the case reported herein differs in these respects. In this report, an incidental finding of EPS is described in a 30-year-old Chinese man, where EPS presents as an anterior mediastinal mass roentgenographically. The mass was attached to the right suprahilar region by a fibrovascular pedicle which contained a small elastic artery, veins, and nerve bundles.