대한흉부영상의학회 Weekly Chest Cases

Case No : 395 Date 2005-05-21

Courtesy of Hyun Ju Lee, M.D. / Seoul National University Hospital, Seoul, Korea
Age/Sex 51 / F
Chief ComplaintIncidentally detected chest PA abnormality

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Diagnosis With Brief Discussion

Diagnosis: Systemic Arterial Supply to the Lung (Left lower lobe)
Radiologic Findings: Posteroanterior chest radiograph shows retrocardiac increased density. Enhanced CT scan shows an enlarged anomalous systemic artery originating from descending thoracic aorta. Lung window of thin-section CT scan shows engorgement of peripheral pulmonary vasculature in the left lower lobe.
Brief Review: Anomalous systemic arterial supply to the normal basal segments of the left lower lobe (systemic arterialization of the left lower lobe without sequestration) is a rare congenital anomaly. In this anomaly, an aberrant systemic artery originating from the descending thoracic aorta rather than the normal lower lobar pulmonary artery supplies the otherwise normal basal segments of the lower lobe. The involved lung parenchyma has no structural or bronchial abnormalities, which distinguishes this entity from classic bronchopulmonary sequestration.

Chest radiographic findings of anomalous systemic arterial supply to the normal basal segments of the lower lobe of the left lung include a lobulating retrocardiac mass, 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. On CT scan, diffuse dilatation of peripheral pulmonary vasculature and areas of ground-glass opacity with mild volume decrease were almost always noted in the involved basal segments.
References: 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.
Keywords: Lung, Congenital,

No. of Applicants : 33

▶ Correct Answer : 14/33, 42.4%

- Kosin University Bokum Hospital, Korea Seong Hyup Kim
- Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
- Jikei University of Medicine, Japan Shigeki Misumi
- IRCCS S.Luca Hospital, Milano, Italy Filippo Casolo
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Hanyang University Hospital, Seoul, Korea Mi Jeong Chang
- Kuk-gun Jigu Hospital, Korea Joon Won Kang
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Seoul National University Hospital, Korea Dae Sik Kim
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi

▶ Semi-Correct Answer : 2/33, 6.1%

- The Ohio State University, Columbus, Ohio Sumit K. Seth
- Annecy Hospital, France Gilles Genin

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 395 Date 2005-05-21

Discussion

No. of Applicants : 33