Anomalous systemic arterial supply to normal basal segments of left lower lobe: characteristic imaging findings

Surgical treatment of abnormal systemic artery to the left lower lobe: A case report

BACKGROUND

Abnormal systemic artery to the left lower lobe is a rare congenital abnormality characterized by anomalous communication between the systemic and pulmonary circulation. Owing to its rarity, there is limited clinical experience with respect to the diagnosis and treatment of this disease.

CASE SUMMARY

We report a 60-year-old man who presented with a history of hemoptysis for 20 d. Contrast-enhanced computed tomography of the chest confirmed the diagnosis of abnormal systemic artery to the left lower lobe, and surgical treatment was performed. The aberrant artery arising from the descending thoracic aorta was ligated, followed by removal of the left lower lobe. The patient showed good recovery and was discharged 6 d after the surgery. At the 1-year follow-up, the patient had recovered completely, and lung CT showed no abnormal findings.

CONCLUSION

We present a case of abnormal systemic artery to the left lower lobe that was successfully managed by surgical resection of the aberrant artery and the left lower lobe. This case report adds to the clinical experience of diagnosing and treating this rare entity.

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.

Anomalous Systemic Artery to the Left Lower Lobe: Literature Review and a New Surgical Technique

Anomalous systemic arterial supply to the basal segments of the left lower lobe without coexisting pulmonary artery connection is a rare anomaly. Most feel treatment is necessary; however, the ideal strategy is unclear. Treatments described include embolization, pulmonary resection, or anastomosis to the native pulmonary artery. We recently encountered an infant with this anomaly and present a literature review summarizing all recent reports. Additionally, we describe a novel surgical technique to create a tension-free anastomosis utilizing segmental aortic translocation that we employed in our patient due to a large distance between the anomalous vessel and native left pulmonary artery.

Comparison of anomalous systemic artery to left lower lobe and pulmonary sequestration in left lower lobe by computed tomography

BACKGROUND

Differentiation of anomalous systemic artery to the left lower lobe (ASALLL) from pulmonary sequestration (PS) is essential, as ASALLL can be corrected by anastomosis, embolization, or ligation of the anomalous artery.

PURPOSE

To compare computed tomography (CT) findings of ASALLL and PS in the left lower lobe (LLL).

MATERIALS AND METHODS

This study included 16 patients with ASALLL and 25 patients with PS in LLL confirmed by operative and pathologic findings.

RESULTS

Cough and sputum were more common in PS (84% and 60%, respectively) than in ASALLL (25% and 12.5%, respectively) (P < 0.05). Hemoptysis was more common in ASALLL (100%) than in PS (24%) (P < 0.05). The frequency of ground glass opacity (GGO), normal bronchial distribution, dilated left inferior pulmonary veins, and absence of the interlobar artery distal to the origin of the superior segmental artery in LLL differed significantly between ASALLL and PS. Mass was less common in ASALLL (0%) than in PS (88%) (P < 0.01). The mean diameter of the anomalous artery (11.88 ± 1.13 mm) in ASALLL was significantly larger than that (5.96 ± 0.98 mm) in PS (P < 0.01). The presence of anomalous artery arising from thoracic aorta was not different between ASALLL (100%) and PS (72%).

CONCLUSION

Radiographic indications of ASALLL differ from those of PS in the LLL. Indications that may suggest ASALLL include an enlarged anomalous systemic artery arising from the thoracic aorta, dilated left inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, normal bronchial distribution, and GGO in the LLL.

Rare presentation of pseudosequestration in childhood: CT and CT angiography findings

Anomalous systemic arterial supply to the lungs with normal bronchial branching and pulmonary arterial supply is an unusual variant of the sequestration spectrum. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection. Thorax computed tomography (CT) and CT angiography are non-invasive and useful techniques in making the definitive diagnosis. Herein, we report two paediatric patients with anomalous systemic arterial supply to normal basal segments of the lower lobes.

CT findings of anomalous systemic artery to the left lower lobe: comparison with pulmonary sequestration in the left lower lobe

AIM

To analyse and compare CT findings of anomalous systemic artery to the left lower lobe (ASALLL) and pulmonary sequestration (PS) in the left lower lobe (LLL).

MATERIALS AND METHODS

The present study cohort comprised 16 patients with ASALLL and 25 patients with PS in the LLL confirmed by surgical and pathological findings. Medical records and CT images were reviewed retrospectively.

RESULTS

Cough and sputum were more common in PS (84% and 60%, respectively) than in ASALLL (25% and 12.5%, respectively; p < 0.05). Haemoptysis was more common in ASALLL (100%) than in PS (24%; p < 0.05). The frequency of ground-glass opacity (GGO), normal bronchial distribution, dilated left inferior pulmonary veins, and absence of the interlobar artery distal to the origin of the superior segmental artery in the LLL differed significantly between ASALLL and PS. A mass was less common in ASALLL (0%) than in PS (88%; p < 0.01). The mean diameters of the anomalous artery (12.10 ± 1.49 mm) and left inferior pulmonary veins (13.20 ± 2.19 mm) in ASALLL were significantly larger than those (6.73 ± 2.59 mm, 10.04 ± 1.55 mm) in PS. The threshold diameters of the anomalous artery and left inferior pulmonary vein for ASALLL were 9.75 and 11.75 mm, respectively. The presence of an anomalous artery arising from the thoracic aorta was not different between ASALLL (100%) and PS (72%).

CONCLUSION

The following imaging features favour ASALLL over PS in the LLL: a larger anomalous systemic artery arising from the thoracic aorta, dilated left inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, normal bronchial distribution, and GGO in the LLL.

Multidetector computed tomography in life-threatening hemoptysis

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).

Anomalous systemic vessel to the lung with hypoplastic left heart syndrome in a fetus

We report a case of a fetus with hypoplastic left heart syndrome in addition to an anomalous vessel extending from the descending thoracic aorta to the basal segments of the lower left lung without sequestration. The concurrence of these 2 congenital abnormalities is extremely rare and unreported in the existing literature. The anomalous vessel to the left lung may cause increased pulmonary vascular resistance, which has implications for the long-term management of hypoplastic left heart syndrome via the Fontan procedure.

[Persistent pleuropneumopathy in a young woman]

Bronchopulmonary sequestration is a rare malformation characterized by lung tissue fed by one or several aberrant systemic arteries. The authors present the case of a 35-year-old woman in whom extralobar sequestration was fortuitously detected at the time of persistent pleuropneumopathy. Computed tomography was used in the diagnosis of pulmonary sequestration. The most common and recommended treatment is the surgical removal of the pulmonary sequestration.

Ethnicity relation to anomalous systemic arterial supply to normal basal segments of the left lower lobe

A 24-year-old female with an anomalous systemic arterial (ASA) supply to normal basal segments of the left lower lobe (LLL) has been suffering from occasional hemoptysis for the last 4.5 years. Our hospital has been following her up for the last 2.5 years. In the first chest radiograph, an unobvious retrocardiac hazy nodule was shown. The following chest computed tomography scan performed indicated clearly this anomaly. According to our analysis of similar reported cases in the English medical literature, the statistics suggest a close relation between Asian population and this anomaly. Therefore, ASA supply to normal basal segments of the LLL should be put into consideration when examining an Asian patient with symptoms of hemoptysis or exertional dyspnea but showing no obvious image findings in chest radiographs.

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.

[Sequestration of the posterobasal segment of the right lower pulmonary lobe]

Pulmonary sequestration is a rare congenital malformation that receives its blood supply from a systemic artery. We report a case of pulmonary sequestration treated by ligature of the anomalous artery without pulmonary resection. Pulmonary sequestration must be treated surgically before the occurrence of severe complications.

Unusual Systemic Artery to Pulmonary Artery Malformation Without Evidence of Systemic Disease, Trauma or Surgery

Connections between the systemic and pulmonary arterial systems are rare conditions that can be due to either congenital or acquired diseases such as anomalous systemic arterial supply to normal lung, pulmonary sequestration, and systemic supply to pulmonary arteriovenous malformations. Herein, a unique case of systemic artery to pulmonary arterial malformation and its endovascular treatment in a patient with no history of the usual etiologies is reported.

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.

Spontaneous Dissection of an Anomalous Systemic Artery in the Lung During Pregnancy: A Rare Cause of Hemoptysis

We report a rare case of spontaneous dissection of an anomalous systemic artery supplying a normal basal segment of the right lung during pregnancy, leading to recurrent hemoptysis. This article aims to discuss the clinical presentation, diagnostic curiosity, management using a minimally invasive technique (video-assisted thoracoscopic lobectomy), and finally the histopathologic findings.

Severe hemoptysis from dilated systemic aberrant arteries supplying normal lung segments

Hemoptysis is an uncommon presentation in children. It can be caused by several systemic and pulmonary disorders. Bleeding from an anomalous arterial supply to normal lung segments with no underlying pulmonary or cardiovascular disorders was widely reported in adults but is extremely rare in the pediatric age group. Here we describe 4 previously normal children and one girl with chronic lung disease, secondary to bronchopumonary dysplasia, with acute and significant hemoptysis of variable severity. Extensive clinical and laboratory investigations did not identify any reasonable causes for their symptoms. Cardiac catheterization showed dilated anomalous systemic arteries that supplied a pulmonary arteriovenous malformation in one case and normal basal lung segments in the other 4 cases. Embolization of the anomalous arterial collaterals led to occlusion of these arteries and the cessation of further hemoptysis.

Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography

PURPOSE

To retrospectively evaluate bronchial and nonbronchial systemic arteries at multi-detector row helical computed tomography (CT) compared with conventional angiography in patients undergoing endovascular treatment of hemoptysis.

MATERIALS AND METHODS

Neither institutional board approval nor informed consent was required. Forty-eight consecutive patients (39 men, nine women; mean age, 55.7 years; range, 20-82 years) with hemoptysis of bronchial and nonbronchial systemic artery origin underwent multi-detector row helical CT angiography of the thorax with use of a four-detector row (n = 31) or 16-detector row (n = 17) scanner prior to embolization. Findings on CT angiograms, including CT scans, maximum intensity projections, and three-dimensional volume-rendered images, were used to evaluate the depiction of bronchial and nonbronchial systemic arteries. Retrospective analysis of the ostium and the course of bronchial and/or nonbronchial systemic arteries on CT angiograms enabled evaluation of the accuracy of this technique in identification of the relevant vasculature.

RESULTS

Among the 46 patients initially treated with bronchial artery embolization, 58 bronchial arteries were identified at CT and/or angiography. In 50 (86%) cases, concordant findings were observed with both modalities. In five (9%) cases, CT could not be used to identify the ostia of bronchial arteries. In three (5%) cases, CT depicted bronchial arteries that could not be selectively catheterized. Three-dimensional images were found to be superior to transverse CT scans in depicting the ectopic origin of the bronchial arteries, which enabled the interventional radiologists to perform successful embolization after direct catherization of the ectopic vessel in every case. In five (11%) patients, the nonbronchial systemic origin of bronchial bleeding was identified on CT angiograms.

CONCLUSION

Multi-detector row helical CT angiography provides more precise depiction of bronchial and nonbronchial systemic arteries than does conventional angiography.