Operation for an anomalous systemic arterial supply to the left lower lobe using an anastomosis procedure in an infant

Anomalous systemic arterial supply to the left lower lung lobe: A case report

Background

An anomalous systemic arterial supply to the lung lobes is a rare congenital pulmonary vascular malformation. Current treatments include thoracoscopic lobectomy, anatomical segmentectomy, simple ligation and arterial embolization. However, the optimal treatment remains controversial.

Case presentation

A 29-year-old man was diagnosed with anomalous systemic arterial supply to the left lower lobe through contrast-enhanced computed tomography and three-dimensional reconstruction. He underwent coil embolization of the anomalous artery and was followed up for 1 year.

Conclusions

Blockage of the blood flow of the anomalous systemic artery alone does not improve the blood supply of the pulmonary artery to lung tissue and thus cannot restore normal gas exchange through the blood-gas barrier. Coil embolization of the anomalous arterial supply can cause early postoperative pulmonary infarction.

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 Arterial Supply to the Lung: To Which Category Should This Belong?

BACKGROUND

The nomenclature of both intralobar pulmonary sequestration (ILS) and aortic origin of a pulmonary artery (AOPA) remains controversial. According to this review, both ILS and AOPA have an anomalous systemic arterial supply to all or part of the lung with venous drainage into the pulmonary veins, which leads to pulmonary hypertension, congestive heart failure, and fatal pulmonary haemorrhage. The purpose of this review was to consider whether these two rare congenital anomalies have similar anatomical, clinical and pathological characteristics.

METHODS

This review was conducted by researching relevant literature using PubMed and MEDLINE databases to January 2019. All researched literature was related to the anatomical, associated anomalies, pathophysiology and clinical features of the extralobar pulmonary sequestration (ELS), ILS, and AOPA, and the therapeutic method for ILS and AOPA.

RESULTS

Through research literature, it was found that ILS and AOPA may differ in terms of embryonic origin, but some of the anatomical, histopathological, physiological and clinical features of these two congenital malformations are similar. However, ELS and ILS have significant differences in their anatomical, histopathological, physiological, and clinical features.

CONCLUSIONS

This study proposes that ILS and AOPA could be classified as one single condition - systemic arterialisation of the lung - and further divided into three subtypes, namely: types I, II and III. This new classification nomenclature permits the appropriate change of novel surgical techniques, which obviate the need for lobectomy or segmentectomy in specific cases, thereby minimising fatal postoperative complications.