대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Aneurysm of aberrant systemic artery to the lung

Radiologic Findings

CT angiography of the aorta demonstrates an aneurysm of an anomalous artery arising from the descending thoracic aorta. This anomalous artery was 7mm in diameter, arising from the left lateral side of the tortuous descending thoracic aorta, and entering into the lung parenchyma of the left lower lobe. Aneurysmal dilatation with surrounding hematoma developed within the anomalous artery, and the maximal diameter of the aneurysm was 7.3cm. Volume rendering reformation images of CT angiogram clearly show the aneurysm of aberrant artery arising from the descending thoracic aorta. Heart and pulmonary vessels have been removed for optimal visualization. There was no obvious communication with pulmonary veins.
The patient was treated successfully with left lower lobectomy and resection of the aneurysmal aberrant artery

Brief Review

Systemic arterial supply of the normal lung is a rare congenital abnormality of the pulmonary blood supply. Furthermore, an aneurysm of the aberrant artery to lung is extremely rare with only several reported cases in the literature.
Systemic arterial supply to apparent normal lung is derived embryologically as a persistent primitive aortic branch that originally supplied the developing lung bud. Naturally, these aortic connections regress as the main pulmonary artery develops. However, in cases of transition failure, persistent systemic arterial communication continues to be the major blood supply to a normal lung. The artery is frequently tortuous, and larger than ordinary vessels.
Radiographically, the anomalous artery appears as an ill-defined nodular area of increased opacity on a posteroanterior chest radiograph. Origin and course of the anomalous artery can be visualized with contrast enhance CT, with the help of, multiplanar display, and 3D reconstructions. The anomalous artery is seen as an enhancing linear or tubular structure coursing from the lower thoracic or upper abdominal aorta through the inferior pulmonary ligament into the involved lung. CT shows not only systemic vessels but also characteristic parenchymal lesions and associated findings.

References

1. Servet Tatli, E. Kent Yucel, Gregory S. Couper, Joel M. Henderson and Yolonda L. Colson. Aneurysm of an Aberrant Systemic Artery to the Lung. American Journal of Roentgenology 2005;184:1241-1244
2. Janssen DP, Schilte PP, De Graaff CS, Van Dijk HA. Bronchopulmonary sequestration associated with an aneurysm of the aberrant artery. Ann Thorac Surg 1995; 60:193-194
3. Sudo H, Shimizu T, Fukushima H, Ishikawa M, Ishimaru S, Furukawa K. A case of aberrant left pulmonary basal aneurysm arising from the descending aorta [in Japanese]. Nippon Kyobu Geka Gakkai Zasshi 1992; 40:96-101
4. Koyama A, Sasou K, Nakao H, et al. Pulmonary intralobar sequestration accompanied by aneurysm of an anomalous arterial supply. Intern Med 1992; 31:946-950

Keywords

Vascular, Congenital,