대한흉부영상의학회 Weekly Chest Cases

Case No : 1111 Date 2019-02-11

Courtesy of Eun Ji Lee, Jun Ho Kim, Kyung Hee Lee / Inha University Hospital
Age/Sex 21 / F
Chief ComplaintHemoptysis

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Diagnosis With Brief Discussion

Diagnosis: Anomalous systemic arterial supply to the normal lung
Radiologic Findings: Chest simple radiographs show ill-defined retrocardiac opacity corresponding to the anomalous artery.
Contrast enhanced axial chest CT scan shows arterial supply from thoracic aorta and enlarged draining right pulmonary vein in basal segment of LLL and mild interlobular and intralobular septal thickening in LLL with GGO, suggesting an area of relative hypervascularity and/or intra-alveolar hemorrhage.
Brief Review: Systemic arterialization of the lung without pulmonary sequestration is the rarest form of anomalous systemic arterial supply to the lung. This condition is characterized by an aberrant arterial branch arising from the aorta which supplies an area of lung parenchyma with normal bronchopulmonary anatomy.
The basal segments of left lower lobe are the most commonly affected site, although rarely other sites can be affected. The systemic artery most commonly arises from the thoracic aorta, but can arise from abdominal aorta or celiac axis and even more rarely from left subclavian and internal mammary artery.
Most patients are asymptomatic. The most common symptom is hemoptysis. Other manifestations include exertional dyspnea, murmur.
A retrocardiac tubular structure or a focal area of consolidation may be evident on chest X-Ray. Computed tomography may reveal a focal area of ground glass density, indicating an area of relative hypervascularity and/or intra-alveolar hemorrhage. CT can also demonstrate an aberrant systemic arterial supply to part of the lung. Thoracic CT is the most useful test in the evaluation of patients with suspected abnormal systemic arterial supply to the lung, as it demonstrates both the bronchial and vascular anatomy of the lung. CT angiography can clearly depict the origin of the aberrant systemic artery. MRI has also been reported to be useful in identifying an anomalous vessel originating from the aorta.
The radiological differential diagnoses include true sequestration and, less likely, hypogenetic lung syndrome. On plain radiograph, intralobar sequestration usually manifests as an intrapulmonary lesion in the left lower lobe. Extralobar sequestration commonly appears as a single, well-defined homogenous opacity located in the pleural space between the left lower lobe and the diaphragm. Evidence of a homogenous or heterogeneous lung mass supplied by a systemic arterial branch on CT should raise suspicion of lung sequestration. MRI can be useful to differentiate the cystic, solid, hemorrhagic and mucous components of the lung mass, as well as providing details of the venous drainage and the abnormal systemic artery. On the other hand, hypogenetic lung syndrome is associated with volume loss of the right lung, which is usually evident on chest X-Ray. CT angiography and MRI reveal the typical vascular abnormalities of this rare condition.
Treatment options include surgery (lobectomy and segmentectomy), when aberrant systemic artery is the only supply, and occlusion of the aberrant vessel by surgical ligation or endovascular treatment.
References: 1. Kyung-Hyun Do, Jin Mo Goo, Jung-Gi Im, Kyoung Won Kim, Jin Wook Chung, Jae Hyung Park. “Systemic Arteri al Supply to the Lungs in Adults: Spiral CT Findings” Radiographics 2001
2. Marcela Mautone, Parm Naidoo. “A case of systemic arterial supply to the right lower lobe of the lung: imaging findings and review of the literature” J Radiol Case Rep. 2014 Mar; 8(3): 9–15.
3. Ashu Seith Bhalla, Pankaj Gupta, Amar Mukund, Arvind Kumar, and Mudit Gupta. “Anomalous Systemic Artery to a Normal Lung: A Rare Cause of Hemoptysis in Adults” Oman Med J. 2012 Jul; 27(4): 319–322.
4. Bo Ra Kim, MD, Jeong-Hyun Jo, MD, Byeong-Ho Park, MD. Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review. J Korean Soc Radiol 2017;76(6):395-402.
Please refer to: Case 824
Keywords: Vascular, congenital,

No. of Applicants : 88

▶ Correct Answer : 52/88, 59.1%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Niigata University , Japan ATSUSHI UEHARA
- The University of Tokyo Hospital , Japan MASAFUMI KAIUME
- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- Ajou University School of Medicine , Korea (South) JUNG YONG JUN
- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- Lille , France BENOIST CAPON
- Chonbuk National University Hospital , Korea (South) EUN HA JUNG
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Other , Korea (South) HEE SEOK CHOI
- Other , Korea (South) SEONGSU KANG
- Seoul National University Hospital , Korea (South) Ju Gang Nam
- The Jikei university , Japan TAKU GOMI
- Kangwon National University Hospital , Korea (South) HAN SOL KANG
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Asan Medical Center , Korea (South) HONG SANG HYUP
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Myongji Hospital , Korea (South) KI EON KWON
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Asan Medical Center , Korea (South) JOOAE CHOE
- Gifu University Hospital , Japan Yo Kaneko
- Samsung Medical Center , Korea (South) MIN YEONG KIM
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Gyeongsang National University Hospital , Korea (South) KWON HWANWOONG
- Ajou University Hospital , Korea (South) HYERIN KIM
- Seoul National University Hospital , Korea (South) SE WOO KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- , Korea (South) KIM JI HOON
- , Korea (South) JANG SEONG WON
- Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
- TB centre kasaragod. , India rikhy krishnan
- Fortis hospital , Mohali , India SHALEEN RANA
- Kizawa Memorial Hospital , Japan Shoji Okuda
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- Yonsei University,Severance Hospital , Korea (South) SUJI LEE
- Ajou University Hospital , Korea (South) SUBIN HEO
- Teikyo University Hospital , Japan KAORU SUMIDA
- Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- , Korea (South) JONGSUN LEE
- Pavilho Pereira Filho , Brazil THIAGO KRIEGER BENTO DA SILVA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 6/88, 6.8%

- Oita University, Faculty of Medicine , Japan Fumito Okada
- Chonnam National University Hospital , Korea (South) SEUNGYOON CHAE
- Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
- Private sector , Greece VASILIOS TZILAS
- , Japan YUMI MAEHARA
- Hamamatsu University Hospital , Japan YUKI HAYASHI

▶ Semi-Correct Answer : 2/88, 2.3%

- McGill University Health Center , Canada Alexandre Semionov
- Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1111 Date 2019-02-11

Discussion

No. of Applicants : 88