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Weekly Chest CasesArchive of Old Cases

Case No : 577 Date 2008-11-17

  • Courtesy of Hye Jeon Hwang, MD, Choong Wook Lee, MD, Kyung Hyun Do, MD. / Asan Medical Center, Korea.
  • Age/Sex 22 / F
  • Chief ComplaintAbnormal finding on preoperative CXR, history of hemoptysis
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Anomalous systemic arterial supply to apparently normal lung
Radiologic Findings
Posteroanterior chest radiograph shows retrocardiac density with partial obliteration of the descending aortic interface. Note increased interstitial markings in left lower lung zone as compared with normal right side. Enhnaced CT scan shows that an enlarged anomalous systemic artery originating from descending thoracic aorta supplies left lower lobe instead of left lower lobar pulmonary artery. Lung window of CT scan shows diffuse engorgement of peripheral pulmonary vasculature and areas of ground-glass opacity in basal segments of the left lower lobe. Note also the mild volume decrease of the left lower lobe.
Brief Review
Systemic arterial supply to apparently normal lung is a rare congenital abnormality of the pulmonary blood supply and the rarest form of congenital anomalous systemic arterial supply to the lungs. An aberrant vessel, usually arising from the descending thoracic aorta, provides the arterial supply of a normal segment of pulmonary parenchyma. The basal segments of the left lower lobe are more frequently involved. Patients with systemic arterial supply to the normal lung may be totally asymptomatic. In the natural course of these patients, however, long-standing left-to-left shunt induces pulmonary hypertension of the affected segments and subsequent symptoms including cough, bloody sputum, dyspnea, and so on. Eventually, left ventricular enlargement and congestive heart failure may develop.
References
1. Ashizawa K, Ishida Y, Matsunaga N et al. Anomalous systemic arterial supply to normal basal segments of left lower lobe: characteristic imaging findings. JCAT 2001:25;764-9.
2. Kim TS, Lee KS, Im JG, Goo JM et al. 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, Vascular, Congenital,

No. of Applicants : 78

▶ Correct Answer : 24/78,  30.8%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Osaka University , Japan Osamu Honda
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Daegu Fatima Hospital , Korea (South) Tae-Hun Kim
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Changi General Hospital , Singapore Angeline Poh
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - radiology department ANNECY , France gilles GENIN
  • - IRCCS S.Luca Hosp. , Italy filippo casolo
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
▶ Correct Answer as Differential Diagnosis : 1/78,  1.3%
  • - Catholic medical center , Korea (South) Hyejung Park
▶ Semi-Correct Answer : 1/78,  1.3%
  • - Korea university anam hospital , Korea (South) SONG GYU
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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