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Weekly Chest CasesArchive of Old Cases

Case No : 552 Date 2008-05-26

  • Courtesy of Hyo Lim Kim, MD. / Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
  • Age/Sex 34 / F
  • Chief ComplaintIncidental abnormality on chest PA
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Complex bronchopulmonary foregut malformation: pulmonary sequestration associated with a esophageal duplication cyst
Radiologic Findings
Chest PA shows a large elongated mass in the right paratracheal region, which has a sharp lateral border. Contrast enhanced CT scans show a dumbbell-shaped, mixed solid and cystic mass located in R paratracheal and prevascular region of the mediastinum. The anterior part of the tumor is composed of soft-tissue mass with inhomogenous enhancement, and the posterior part is composed of cystic mass with smooth and thin wall.

A small curvilinear aberrant artery originating from the R bracheocephalic artery is suspected on sagittal reconstruction image. Surgical excision of the mass was undertaken. The mass was bilobulated, and consisted of solid and cystic components connected with each other. A small feeding artery originating from R bracheocephalic artery was identified. Cystic component of the mass was closely abutting the esophageal wall. Gross pathologic examination showed a malformed lung communicating with the cystic mass. Microscopic examination of the resected specimen revealed findings consistent with pulmonary sequestration and associated esophageal duplication cyst.
Brief Review
Bronchopulmonary foregut malformations(BPFMs) are diverse group of congenital anomalies that may arise from abnormal differentiation of the respiratory and alimentary tracts, abnormal separation of the two systems, or abnormal development of blood supply, during early embryogenesis. This group of malformations includes pulmonary sequestration, congenital cystic adenomatoid malformation, bronchogenic and neurenteric cysts, tracheoesophageal fistula, esophageal atresia, and esophageal, and gastric duplications. The presence of accessory lung tissue that arises from the primitive gastrointestinal tube is the common factor in the development of all forms of BPFMs. The connection to the primitive foregut may or may not involute.

This case is unusual because two components of the BPFM complex coexisted in a single patient. Indentification of feeding artery on CT, directly originating from the systemic circulation might be a clue of bronchopulmonary sequestration.
References
1. Fenton LZ, Williams JL. Bronchopulmonary foregut malformation mimicking neuroblastoma. Pediatr Radiol. 1996;26(10):729-30
2. Kim KW, Kim WS, Cheon JE, et al. Complex bronchopulmonary foregut malformation: extralobar pulmonary sequestration associated with a esophageal duplication cyst. Pediatr Radiol. 2001;31:265-268
3. Sumner TE, Auringer ST, Cox TD. A complex communicating bronchopulmonary foregut malformation:diagnostic imaging and pathogenesis. Pediatr Radiol. 1997;27:799-801
Keywords
Mediastinum, Esophagus, Congenital,

No. of Applicants : 89

▶ Correct Answer : 1/89,  1.1%
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
▶ Semi-Correct Answer : 63/89,  70.8%
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - CHRU lille , France manuel toledano
  • - Osaka University , Japan Osamu Honda
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - St. Mary Hospital , Korea (South) Jung GW
  • - apollo hospitals , India harish bhambore
  • - , Korea (South) Kwon Kim
  • - brm hospital , India chemmandi sudhan
  • - Asan Medical Center , Korea (South) Eun Jin Chae
  • - Asian heart institute, Nirman Hitech & apollo clinic , India Jeshil Shah
  • - McGill University Health Centre , Canada Amr Ajlan
  • - mediciti hospitals , India paramjyothi gongati
  • - chp st martin , France Mariotte benoit
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - University of Kocaeli , The faculty of Medicine , Turkey Salih Topcu
  • - Saint Luke , Korea (South) ui byun
  • - Regional Imaging Ltd. - Riverina , Australia Rashid Hashmi
  • - Yashoda hospital , India satish maddukuri
  • - CATHAY GENERAL HOSPITAL, SIJHIH , Taiwan CHIH-HUNG LIN
  • - kims , India kakarla bhaskar
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - CARE hospital , India umadevi bhagavatula
  • - Apollo Hospital, Ahmedabad. , India Sandip R Shah
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Cheongshim international medical center , Korea (South) yang Hae Jum
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Mackay Memorial Hospital, Taipei , Taiwan Chia-Fu Tsai
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - OSWAL CANCER HOSP. , India vishal garg
  • - hospital Sao Paulo , Brazil israel missrie
  • - Lilavati hospital and Research center , India vivek gupta
  • - Aarthi advanced scan centre.Chennai. , India R.P Babu.
  • - EKH-Berlin , Germany Michael Weber
  • - CMC , Korea (South) An yi
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Aba Prefecture People Hospital竊Œshicuan竊Œchina , China pu peng
  • - Univerisity of Toronto , Canada martin chandonnet
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - radiology department ANNECY , France gilles GENIN
  • - CHRA , France stephanie besse
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - All India Institute of Medical Sciences , India Puneet Kochar
  • - Homs National Hospital , Syria Rami Abou zalaf
  • - Dept. radiology, Chung-Ang univ. , Korea (South) JIN KYOUNG KIM
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRSA La Rochelle France , France Denis Chabassie
  • - Jackson Memorial Hospital , United States Naganathan Mani
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - Pe d , France Fabrice Bing
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - All India Institute of medical sciences , India Justin Moses
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
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