Anomalous systemic arterial supply to the basal segments of the lung presenting with a murmur

Merged image reconstruction for anomalous systemic arterial supply to a normal lung

We present a rare case of anomalous systemic arterial supply to normal basal segments of the left lower lobe. Plain computed tomography (CT) showed an occupancy lesion in the left lower lobe. Contrast CT and merged three-dimensional (3D) image reconstruction showed that the anomalous systemic artery originated from the descending aorta and substituted the basilar segmental pulmonary artery and the arterial supply to the basilar segment of left lower lobe. We use the merged image reconstruction of 3D CT angiography and bronchography (3D-CTAB) to depict the precise location and stereoscopic shape of this vascular malformation. Therefore, we think that these data add a novel comprehensive perspective on the diagnosis of the feature of malformation and treatment planning for this rare disease.

Endovascular treatment of hemoptysis by abnormal systemic pulmonary artery supply

We report the case of a 29-year-old man with hemoptysis. The patient came to the emergency department, where a laboratory test and chest radiograph were reported as normal. The following day the patient again had hemoptysis, though less than previously. He reported no chest pain, dyspnea, fever, catarrh, changes in urine or feces, contact with patients with bacillus disease or constitutional symptoms. Doppler ultrasound of the chest showed right basal parenchymatous condensation containing a vessel with arterial flow (in the opposite direction to the aortic flow) compatible with an aberrant vessel, possibly a sequestration, leaving the aorta above the celiac trunk. Because of the findings of the chest echogram and magnetic resonance study, thoracoabdominal computed tomography angiography was undertaken; this showed right basal condensation and an anomalous vessel originating 1 cm above the celiac trunk, supplying the right lower lobe. An aortic and pulmonary arteriogram via an arterial and right femoral vein approach confirmed the findings. The patient was treated successfully with percutaneous embolization with coils. The relevant literature is reviewed.

Anomalous systemic arterial supply to the lungs: an unusual etiology for cardiomegaly

Anomalous systemic arterial blood supply to the lungs is a rare anomaly of lung development. It may present with various manifestations that are shared with more commonly encountered congenital and acquired heart diseases. Thus, it may evade early diagnosis or even lead to a wrong diagnosis and treatment. This lesion should be suspected in left ventricular overload conditions in the absence of a clear explanation.

[Anomalous systemic arterial supply to the lower lobe of the right lung: a rare finding]

Vascularization of a segment or lobe of the lung from a systemic artery is a rare anomaly. The lower left lobe is usually involved and clinical presentation typically includes hemoptysis, chest pain, exercise-related dyspnea or murmurs. Some patients are asymptomatic and discovery is fortuitous. Diagnosis depends on images, with angiography and, most recently, helicoid CT scan proving most useful. Treatment is nearly always surgical, with or without prior embolization of the anomalous vessel.We report the case of a 31-year-old man with anomalous systemic arterial supply to the lower right lobe discovered while we examined a pulmonary node that appeared benign. The location was unusual. We discuss diagnostic procedures and assess the relation between this condition and lung sequestration and hypogenetic lung syndrome.

Anomalous systemic arterialization to normal basal segments of the left lower lobe: helical CT and CTA findings

PURPOSE

The purpose of this work was to evaluate the helical CT and CT angiography (CTA) findings of anomalous systemic artery (ASA) to the basal segments of the left lower lobe (LLL).

METHOD

Three patients (two had hemoptysis, one was asymptomatic) with blotchy nodular density in the LLL revealed on chest radiographs underwent helical CT and CTA. Bronchoscopy was performed in two of these patients. Angiography and surgery were performed in one patient.

RESULTS

All three patients demonstrated characteristic helical CT and CTA findings including 1) a sigmoid-shaped ASA originating from the lower descending thoracic aorta, with a distal bulbous configuration and four arterial branches supplying the basal segments of the LLL; 2) absence of an interlobar pulmonary artery or presence of a small artery lateral to the truncus basalis; 3) engorged vascular markings in the basal segments of the LLL; and 4) normal tracheobronchial tree and lung parenchyma.

CONCLUSION

The findings in the present three cases suggest that the use of invasive studies such as angiography or bronchoscopy may be obviated in the diagnosis of ASA to the LLL because diagnosis can be provided through a clear set of criteria on helical CT and CTA.

Anomalous systemic arterial supply to normal basal segments of the left lower lobe

BACKGROUND

Anomalous arterial supply to the normal basal segments of the lower lobe without sequestration is a rare congenital abnormality, and whether it belongs to the broad spectrum of sequestration disorders remains controversial.

METHODS

The cases of all 4 patients who were treated surgically by us were reviewed together with 8 previously reported cases.

RESULTS

The anomalous artery originated from the descending thoracic aorta, distributed to the basal segments of the left lower lobe, and drained to a normal inferior pulmonary vein in each case. The anomalous artery was thick and elastic walled. From the review of all 12 cases, male gender, left side, descending thoracic aorta as the aberrant arterial origin, absence of pulmonary blood flow to the basal segments, and normal pulmonary venous drainage were predominant. Despite some differences, the findings seemed closely related to intralobar sequestration. Surgical treatments were lung resection, anastomosis, and ligation of the anomalous artery.

CONCLUSIONS

This anomaly is probably one type of sequestration complex. Both aortic and pulmonary arterial angiographic studies are needed to plan the definitive surgical procedure.

Anomalous systemic arterial supply to normal basal segments of the left lower lobe. A report of two cases

Two cases of anomalous systemic arterial supply to the basal segments of the lower lobe of the left lung without sequestration are presented. In the first case, the final diagnosis was made during a surgical operation, and lobectomy of the lower lobe of the left lung was performed. In the second case, the preoperative diagnosis made by CT was confirmed by angiography. An anastomosis was performed between the anomalous artery and the pulmonary artery without resection of the basal segments. Six months after surgery, pulmonary angiography showed improved flow of the anastomosed vessel, but little improvement was evidenced in the perfusion scan.

Intralobar pulmonary sequestration (a nonentity?)

Intralobar pulmonary sequestration has generally been considered a congenital malformation in which an accessory lung bud develops, is enveloped by normal lung, and retains its systemic arterial supply. Also usually included in the "sequestration spectrum" are aberrant arteries to normal lung with either normal or anomalous venous connection. We reviewed all surgical pathology specimens and autopsies performed at Texas Children's Hospital from 1955 through 1984. There were 15 cases with an aberrant systemic artery to normal or abnormal lung. Nine were cases of structurally normal lung with an aberrant systemic artery, and five were cystic adenomatoid malformations with a systemic artery. In one older child some features of intralobar sequestration were present, but a major bronchial connection was retained. We propose that most intralobar sequestrations represent either cystic adenomatoid malformations that clinically are unrecognized until they become secondarily infected or developmentally normal lung supplied by a systemic artery.

Spectrum of pulmonary sequestration: association with anomalous pulmonary venous drainage in infants

Pulmonary sequestration is a spectrum of related lesions, each of which may be absent or present: (1) bronchial sequestration of pulmonary parenchyma; (2) arterial supply from systemic circulation; (3) anomalous pulmonary venous drainage to the right atrium; (4) communications between bronchus and esophagus; (5) defects of diaphragm; (6) gross lung anomalies, such as horseshoe lungs or hypoplasia. Any combination of these primary lesions can occur in an individual patient. Diagnosis should be directed towards each component of the spectrum. Of special importance is the venous connection, as anomalous pulmonary venous drainage can involve not only the sequestered segment but the entire ipsilateral lung, making surgical therapy far more complex. Treatment of choice is surgical resection, associated, if needed, with rerouting of the pulmonary venous return. Classification of sequestration of the lung as intra- and extralobar is of secondary importance: these 2 groups do not represent lesions of different embryological significance.