대한흉부영상의학회 Weekly Chest Cases

Case No : 679 Date 2010-10-31

Courtesy of Ju Won Lee, Kyung Hee Lee / Inha University Hospital
Age/Sex 16 / F
Chief ComplaintAsymptomatic

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Diagnosis With Brief Discussion

Diagnosis: Extralobar pulmonary sequestration
Radiologic Findings: Chest CT scans show about 3cm sized cystic mass in the left lower hemithorax. It is well-demarcated and abuts posterior pleura. No abnormal abnormality is seen in the chest wall and both lungs. There is no evidence of significant lymphadenopathy in mediastinum.
Brief Review: The patient underwent surgical mass excision. There was no evidence of pleural adhesion or other pleural abnormality. Cystic mass was seen in the posterior mediastinum. No significantly enlarged systemic artery from descending thoracic aorta was seen. On the pathologic report, final diagnosis was extralobar pulmonary sequestration with cystic bronchial dilatation.

Extralobar sequestration is a congenital anomaly, representing approximately 15%-25% of all pulmonary sequestrations. It is invested in its own pleura, consists of lung tissue that lacks a normal communication to the tracheobronchial tree and derives its blood supply from systemic vessels. Arterial supply is usually from the abdominal aorta and drainage is almost always by means of systemic veins (azygos, hemiazygos and inferior vena cava), producing a left-to-right shunt.
Approximately 10% of extralobar sequestrations are found incidentally in asymptomatic individuals. About 50%-65% of patients with extralobar sequestration have associated congenital anomalies. The most common associated congenital anomaly is congenital diaphragmatic hernia (20%-30% of cases).
Chest radiographs often show a single homogeneous opacity or, less commonly, a cystic mass in the base of one lung that can sometimes suggest the diagnosis of sequestration. Characteristic CT manifestations are (a) a complex lesion containing solid or fluid components combined with emphysematous lung or (b) any basal lesion supplied by a systemic artery. CT angiography can facilitate the display of aberrant artery and venous drainage may not be clearly shown on CT. However, supplying artery may not been seen on CT, if it may be as small as 1mm, especially in infants.
Surgery is generally indicated for the treatment. It is important to demonstrate the arterial supply and venous drainage of the sequestered segment preoperatively. Embolization of the anomalous vessels with angiographic techniques may be helpful in reducing operative blood loss.
References: 1. Felker R, Tonkin I. Imaging of pulmonary sequestration. Am J Roentgenol. 1990;154(2):241-9.
2. Frush D, Donnelly L. Pulmonary sequestration spectrum: a new spin with helical CT. Am J Roentgenol. 1997;169(3):679-82.
3. Rosado-de-Christenson ML, Frazier AA, Stocker JT, Templeton PA. From the archives of the AFIP. Extralobar sequestration: radiologic-pathologic correlation. Radiographics. 1993;13(2):425-41.
4. Kang M, Khandelwal N, Ojili V, Rao KL, Rana SS. Multidetector CT angiography in pulmonary sequestration. J Comput Assist Tomogr. 2006;30(6):926-32.
5. Ikezoe J, Murayama S, Godwin JD, Done SL, Verschakelen JA. Bronchopulmonary sequestration: CT assessment. Radiology. 1990;176(2):375-9.
6. Webb W. Congenital Bronchopulmonary Lesions. In: Webb W, ed. Thoracic imaging : pulmonary and cardiovascular radiology. Philadelphia: LWW, 2005; p. 1-29.
Keywords: Lung, Airway, Congenital, Bronchial abnormlity,

No. of Applicants : 83

▶ Correct Answer : 17/83, 20.5%

- kobe city general hospital , Japan rintaro hashimoto
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Kobe City Medical Center General Hospital , Japan Hitomi Nagano
- Doctors Hospital , Bahamas muneesh sharma
- McGill University Health Center , Canada Alexandre Semionov
- NDMVP Nashik , India Imran Jindani
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- chp st martin , France Mariotte benoit
- chungbuk uni. hospital , Korea (South) JY Ahn
- McGill , Canada Marcus Povitz
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
- Vitalife Clinics , Pune , India. , India Rahul Deshmukh
- Montreal , Canada D J
- Bundang CHA hospital , Korea (South) Sojung Kim
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe

▶ Correct Answer as Differential Diagnosis : 24/83, 28.9%

- Song-do Hospital , Korea (South) Ji-young Yun
- University of British Columbia , Canada Amr Ajlan
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- NTUH , Taiwan Kuei-pin Chung
- Onomichi municipal hospital , Japan Ryotaro Kishi
- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- IRSA La Rochelle France , France Denis Chabassiere
- CHRU LILLE , France Vittorio Pansini
- McGill University , Canada Ben Smith
- Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- radiologist, aditya imaging centre , India vivek patel
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- Ondokuz Mayis University , Turkey Cetin Celenk
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- jobless , France jean-baptiste Noel
- Hotel-Dieu Montreal , Canada nicolas gautier
- Hospital M de Deus , Brazil Thiago Bento da Silva
- NASA SCANS , India RAKESH BHATIA
- All India Institute of medical sciences , India Justin Moses
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Asan Medial center , Korea (South) Chae Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 679 Date 2010-10-31

Discussion

No. of Applicants : 83