대한흉부영상의학회 Weekly Chest Cases

Case No : 417 Date 2005-10-24

Courtesy of Yookyung Kim, MD / Ewha Womans University, MokDong Hospital, Seoul, Korea
Age/Sex 19 / M
Chief ComplaintRecurrent pneumonia in left lower lobe

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary Sequestration, Intralobar Type
Radiologic Findings: Chest radiograph shows reticular opacities in left lower lung zone. Also noted is cardiac shifting to the right, which is suggestive of increased volume of LLL. High-resolution axial CT scans show ill-defined areas of small cysts, linear and ground-glass opacities, and air trapping in LLL with anterior displacement of left major fissure. A tubular structure is noted in posterior basal segment of LLL, which is corresponding to the systemic supplying artery arising from the aorta on coronal maximum intensity projection image. Lung window coronal reformation images well demonstrate volume increase of LLL with ill-defined areas of multiple cysts in posterior inferior region of LLL.
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 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.

Ikezoe and associates found a surprisingly high incidence of "emphysema" in the lung adjacent to both intralobar and extralobar sequestrations. Emphysema adjacent to intralobar sequestrations has been explained on the basis of collateral air drift and air trapping caused by impaired ventilation.
References: 1. Ikezoe J, Murayama S, Godwin JD, Done SL, Verschakelen JA. Bronchopulmonary sequestration: CT assessment. Radiology 1990;176:375-379

2. Stern EJ, Webb WR, Warnock ML, Salmon CJ. Bronchopulmonary sequestration: dynamic, ultrafast, high-resolution CT evidence of air trapping. AJR Am J Roentgenol 1991;157:947-949

Refer to the case 12 and case 32
Keywords: Lung, Congenital,

No. of Applicants : 36

▶ Correct Answer : 20/36, 55.6%

- B.J.Medical College, University of Pune (retired), India Bankim J. Amin
- Kyungpook National University Hospital, Korea Han Young Jung
- Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
- Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
- Centre Hospitalier Lyon Sud, France Van-Andre Tran-Minh
- Hospital Principe de Asturias, Madrid, Spain FJ Guez de Terreros Caro
- Ismalia Chest Hospital,Ismailia,Egypt Zakaria Elzoghbi
- Chikuhou Rousai Hospital, Japan Uchida Kouei
- Nizam's Institute of Medical Sciences Umadevi Malladi
- Hereford County Hospital, UK. Joy A Thomas
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- IRCCS S.Luca Hospital, Milano, Italy Filippo Casolo
- MH (CTC), Pune, India Vivek Sharma
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
- Ohio State University Medical Center, Columbus, USA Hari Charan P. Reddy

▶ Correct Answer as Differential Diagnosis : 5/36, 13.9%

- Seoul National University Hospital, Korea Eun Ju Chun
- Annecy Hospital, France Gilles Genin
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Max Hospital, New Delhi, India Vickrant Malhotra
- Max Hospital, New Delhi, India Anurag Jain

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 417 Date 2005-10-24

Discussion

No. of Applicants : 36