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Weekly Chest CasesArchive of Old Cases

Case No : 749 Date 2012-03-05

  • Courtesy of Sang Young Oh, Sang Min Lee, Dong Hyun Yang, Joon Beom Seo / Anan medial ceter
  • Age/Sex 55 / M
  • Chief ComplaintIncidental finding on coronary CT angiography
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Bilateral Pulmonary Sequestration with Bridging Isthmus
Radiologic Findings
A CT scan showed the presence of multicystic masses in medial basal segments of bilateral lower lobes with midline bridging isthmus. The lesions received the blood supply from an aberrant artery, a branch of the abdominal aorta. On volume rendering reconstructed image, there are multiple feeders originated from the ascending aorta.

Figure 6.

Brief Review
Pulmonary sequestration is a relatively rare disorder, and is defined as a segment of the lung parenchyma that lacks communication with the tracheobronchial tree and receives an aberrant systemic arterial blood supply. The anomaly can be either intralobar or extralobar (1). Bilateral pulmonary sequestration is a rare anomaly (2).
The presence of a bridging isthmus between bilateral pulmonary sequestrations is extremely rare (3). Bilateral pulmonary sequestrations with a bridging isthmus may mimic a horseshoe lung. A horseshoe lung is formed from the joining of bilateral lung bases by an isthmus of lung parenchyma behind the heart. The arterial supplies to the isthmic portion of a horseshoe lung are almost always the branches from the pulmonary artery (4, 5). Most of the reported cases have been associated with a certain degree of pulmonary hypoplasia (6). The feeding artery of the mass in our case turned out to be an aberrant arterial branch from the abdominal aorta.
References
1. Son RC, Lee JK, Hwang MS. Bilateral pulmonary sequestration with a bridging isthmus in an elderly person: A case report. J Korean Soc Radiology 2009;61:105-107.
2. Carrion-Valero F, Marin-Pardo J. Pulmonary sequestration. Respiration 2003;70:528.
3. Srikanth MS, Ford EG, Stanley P, Mahour GH. Communicating bronchopulmonary foregut malformations: classification and embryogenesis. J Pediatr Surg 1992;27:732-736.
4. Kuo R, Shih SL, Huang JK. On the AJR digital viewbox. Bilateral pulmonary sequestration with bridging isthmus in a boy with Williams syndrome. AJR Am J Roentgenol 2006;187:W133-134.
5. Figa FH, Yoo SJ, Burrows PE, Turner-Gomes S, Freedom RM. Horseshoe lung-a case report with unusual bronchial and pleural anomalies and a proposed new classification. Pediatr Radiol 1993;23:44-47.
6. Hawass ND, Badawi MG, Fatani JA, Meshari AA, Edrees YB. Horseshoe lung with multiple congenital anomalies. Case report and review of the literature. Acta Radiol 1987;28:751-754.
7. Lutterman J, Jedeikin R, Cleveland DC. Horseshoe lung with left lung hypoplasia and critical pulmonary venous stenosis. AnnThorac Surg 2004;77:1085-1087.
Keywords
lung, congenital,

No. of Applicants : 95

▶ Correct Answer : 78/95,  82.1%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
  • - radiologist, aditya imaging centre , India vivek patel
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Korea university , Korea (South) Kun Woo Kang
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - HUEC , Brazil Diogo Pinheiro
  • - University of British Columbia , Canada Amr Ajlan
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Hanam sungshim hospital , Korea (South) CHANG IL KIM
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - GwangmyeongInHospital , Korea (South) Ju Won Lee
  • - Iwate Medical University , Japan KOYO KIKUCHI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Bundang CHA hospital , Korea (South) Sojung Kim
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Kangdong Kyunghee university medical center , Korea (South) Soyoun Shin
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - H�pital du Sacr , Canada Andrea Ojanguren
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - National Jewish Health , United States Jonathan Chung
  • - Suncheon Plus Medicine , Korea (South) Park Sang Hyun
  • - Okayama University Hospital , Japan Yoshihisa Masaoka
  • - CH lyon Sud , France matthieu ROUSSET
  • - Montreal , Canada Drago Le King
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Korea University Guro Hospital , Korea (South) Kyungwon Doo
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - fmmc , India subas kandimalla
  • - HIA Legouest - METZ , France Alban Gervaise
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Shree Diagnostics , India amol jagdale
  • - NDMVP Nashik , India Imran Jindani
  • - MASAN , Korea (South) Kim Sang Hyeon
  • - Myongi , Korea (South) soon Moon
  • - Dept. Radiology, Kyungpook medical school hosipital , Korea (South) Hyejin Cheon
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - Iwate Medical University , Japan Akio Akahane
  • - Samsung Medical Center , Korea (South) Jihyun LEE
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - EKH-Berlin , Germany Michael Weber
  • - aarthi scans , India abirami mahadevan
  • - All India Institute of medical sciences , India Justin Moses
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India;Visitng Prof of Thoracic Surgery KLE University Belgaum , India Bankim Amin
  • - , Korea (South) Seung Soo Kim
  • - CHRU Lille , France Paul Lebert
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - IRSA , France, Metropolitan BIGOT
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - CLCC , France nicolas gautier
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - NASA SCANS , India RAKESH BHATIA
  • - CHU Saint Pierre , Belgium Abd Alla Fares
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Private sector , Greece Vasilios Tzilas
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Azienda Ospedaliera San Gerardo , Italy Gabriele DAndrea
  • - Okayama university , Japan Mayu Uka
  • - KUMC ansan , Korea (South) kihwan kim
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - shengjing hospital china medical university , China yue yong
▶ Correct Answer as Differential Diagnosis : 9/95,  9.5%
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - CHRU lille , France manuel toledano
  • - Travancore Medical College , India Chary D
  • - XiangYa hospital , China Xia Yu
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - chp st martin , France Mariotte benoit
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