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Weekly Chest CasesArchive of Old Cases

Case No : 700 Date 2011-03-29

  • Courtesy of Youkyung Lee / Seoul National University Bundang Hospital
  • Age/Sex 20 / M
  • Chief ComplaintHemoptysis (5 days ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Fig 1

Diagnosis With Brief Discussion

Diagnosis
Anomalous systemic arterial supply to the normal lung
Radiologic Findings
We can see ill-defined consolidation and ground glass opacities in the left lower lobe basal segments, which are probably aspirated blood. It is interesting of notes, an aberrant artery arising from distal descending aorta supplies the left lower lobe basal segments and the left lower lobe have normal bronchi and normal pulmonary venous drainage. We can also see mild engorgement of pulmonary vein draining the lesion, which is probably due to congestion from high pressure from systemic artery supply.

Fig 6

Fig 7

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
Vascular, Lung, Congenital,

No. of Applicants : 103

▶ Correct Answer : 36/103,  35.0%
  • - Korea Unuversity Guro hospital , Korea (South) Kyung-ah Lee
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Severance hospital , Korea (South) Saerom Hong
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - soonchunhyang bucheon hospital , Korea (South) Sun Jeong
  • - Okayama University , Japan Akihiro Tada
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - SMC , Korea (South) Yi Kyung Kim
  • - Gifu Chuo Hospital , Japan Yo Kaneko
  • - Shiga university of medical science , Japan Akitoshi Inoue
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Istanbul , Turkey Armagan Sarac
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Saga University , Japan Ryoko Egashira
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Saint Malo , France jean-baptiste Noel
  • - Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Severance hospital , Korea (South) Park MIna
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Himeji Red Cross Hospital , Japan ryota inai
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IRSA , France jean-luc BIGOT
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Assam Medical college , India samudra borah
  • - Seoul St Mary Hospital , Korea (South) Chaehun Lim
▶ Correct Answer as Differential Diagnosis : 7/103,  6.8%
  • - radiologist, aditya imaging centre , India vivek patel
  • - CHRU lille , France manuel toledano
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - Hanyang University Hospital , Korea (South) Jina Park
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
▶ Semi-Correct Answer : 2/103,  1.9%
  • - Severance hospital , Korea (South) Beomseok Sohn
  • - KUMC ansan , Korea (South) kihwan kim
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