Archive of Old Cases
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- Archive of Old Cases
- 2012
Case No : 771 Date 2012-08-07
- Courtesy of Ji Won Lee, Yeon Joo Jeong / Pusan National University Hospital
- Age/Sex 22 / M
- Chief ComplaintHemoptysis (4 months ago)
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Systemic arterial supply to the lung (left lower lobe)
- Radiologic Findings
- Lung window of CT scan shows that the vessels of the left lover lobe are hypertrophied in comparison with those of the contralateral lung. Contrast material enhanced CT scan and coronal MIP image show an enlarged anomalous systemic artery originating from descending thoracic aorta. Posteroanterior chest radiograph shows retrocardiac increased opacity in the retrocardiac area.
- Brief Review
- Anomalous systemic arterial supply to the normal basal segments with normal bronchial connection of the lower lobe, which has no normal pulmonary arterial supply without sequestration, is a rare congenital anomaly. The most common clinical manifestation in pediatric patients is a cardiac murmur, but most adult patients are asymptomatic or have recurrent hemoptysis.
Although the cause of systemic arterial supply to normal lung tissue is unknown, it is thought that persistence of an embryonic connection between the aorta and the pulmonary parenchyma leads to this anomaly.
At posteroanterior chest radiography, the anomalous systemic artery appears as an ill-defined nodular area of increased opacity in the medial aspect of the left lower lobe, absence of normal lower lobar pulmonary artery shadow in the left infrahilar region, partial obliteration of the interface of the descending thoracic aorta, and increased interstitial markings in the left lower lung zone. CT scan shows vascular structures with the same attenuation as the thoracic aorta in the left lower lobe. Other CT findings include absence of the interlobar artery distal to the origin of the superior segmental artery, diffuse dilatation of peripheral pulmonary vasculature and areas of ground-glass opacity with mild volume decrease in the involved basal segments.
- References
- 1. Tae Sung Kim, Kyung Soo Lee, Jung-Gi Im, Jin Mo Goo, Jai Soung Park, Jin Hwan Kim. Systemic Arterial Supply to the Normal Basal Segments of the Left Lower Lobe. Radiographic and CT Findings in 11 Patients. Journal of Thoracic Imaging 2002:17;34-39.
2. Kyung-Hyun Do, Jin Mo Goo, Jung-Gi Im, Jae Hyung Park et al. Systemic Arterial Supply to the Lungs in Adults: Spiral CT Findings. Radiograhics 2001:21;387-402
- Keywords
- lung, pulmonary artery, congenital, congenital,
No. of Applicants : 67
- ▶ Correct Answer : 38/67, 56.7%
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- - Kurashiki Seijin-byo Center , Japan Akihiro Tada
- - Dongguk University , Korea (South) Dong Jae Shin
- - Onomichi municipal hospital , Japan Hirofumi Mifune
- - Hanam sungshim hospital , Korea (South) CHANG IL KIM
- - Oita University, Faculty of Medicine , Japan Fumito Okada
- - GM InHospital , Korea (South) Ju Won Lee
- - Seosan Medial Center , Korea (South) Sang Min Lee
- - Teikyo mizonokuchi hospital , Japan Takana Yamakawa
- - Fukuyama city hospital , Japan Ryotaro Kishi
- - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- - IRSA La Rochelle France , France Denis Chabassiere
- - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
- - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
- - UWO , Canada S Lee
- - Seoul St Mary Hospital , Korea (South) Chae Lim
- - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- - Kohka Public Hospital , Japan Akitoshi Inoue
- - SNUH , Korea (South) Euijin Hwang
- - Asan medical center , Korea (South) Sang Young Oh
- - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- - radiologist, aditya imaging centre , India vivek patel
- - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- - Asan medical center , Korea (South) Hyun Joo Lee
- - Asan Medical Center , Korea (South) Ji Eun Kim
- - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- - XiangYa hospital , China Xia Yu
- - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- - CHRU lille , France manuel toledano
- - IRSA , France, Metropolitan BIGOT
- - Hanyang University Hospital , Korea (South) Yo Won Choi
- - Kizawa Memorial Hospital , Japan Yo Kaneko
- - Fortis hospital , Mohali , India Shaleen Rana
- - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
- - Homs National Hospital , Syria Rami Abou Zalaf
- - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- - All India Institute of medical sciences , India Justin Moses
- ▶ Correct Answer as Differential Diagnosis : 4/67, 6.0%
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- - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- - McGill University Health Center , Canada Alexandre Semionov
- - University of British Columbia , Canada Amr Ajlan
- - Kyung Hee University Medical center , Korea (North) Myung You
- ▶ Semi-Correct Answer : 13/67, 19.4%
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- - KMC,Manipal , India satish maddukuri
- - James Paget Hospital , U.K , United Kingdom nabil mahmood
- - Ondokuz Mayis University , Turkey Cetin Celenk
- - Kaohsiung Veteren , Taiwan Ying-kai Huang
- - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- - Himeji St.Mary Hospital , Japan Yuichiro Kanie
- - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- - CHU NANCY , France, Metropolitan LEGOU Francois
- - Mashhad University of Medical Sciences , Iran Bita Abbasi
- - aarthi scans , India abirami mahadevan
- - CHU Poitiers , France CHAN paul
- - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- - CAC Rennes , France nicolas gautier
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