대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

lntralobar Bronchopulmonary Sequestration with Infection

Radiologic Findings

The cystic mass contains air-fluid level in the left lower lobe on chest radiograph. HRCT and conventional CT lung window setting show thin walled multilocular cystic mass with air-fluid level and surrounding pneumonic infiltration, which was not seen CT scan obtained 1 year ago. Any vessel was not visualized on CT examination.

Gross specimen shows well-defined multilocular cyst and internal pus (not shown). A 6mm sized feeding artery originating from descending thoracic aorta was detected on operation.

Brief Review

Intralobar sequestrations often have ill-defined margins and resemble an area of pneumonia, although they may have rounded or lobulated contours and resemble an intrapulmonary mass. On occasion, one or more air-fluid levels are seen within sequestered segments. Such air-fluid levels are a consequence of infection with fistula formation to the adjacent bronchi. Although sequestrations may appear solid on plain radiographs, CT usually shows an irregular cystic component to the lesion. The demonstration of a systemic artery supplying the lesion is the critical diagnostic feature. Aortography is particularly important if surgical treatment is being considered because inadvertent damage to the artery during surgery can cause significant hemorrhage. The systemic artery can also be demonstrated by CT using intravenous contrast enhancement or occasionally by Doppler ultrasound. The presence of absence of a systemic arterial supply is the critical feature in the differential diagnosis from bronchogenic cysts. The infected pulmonary sequestration may contain fluid levels and have an ill-defined edge because of inflammatory changes in adjacent lung. The appearance therefore may exactly mimic a simple lung abscess, and only the position of the lesion may lead to suspicion of an infected pulmonary sequestration.

References

1. Armstrong P. Imaging of diseases of the chest. 2nd ed. Mosy. 621-626
2. Pare F. Synopsis of disease of the chest. 2nd ed. Saunders. 258-262

Keywords

Lung, Congenital, infection,