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Weekly Chest CasesArchive of Old Cases

Case No : 1428 Date 2025-03-03

  • Courtesy of Suyon Chang / Seoul St. Mary's Hospital
  • Age/Sex 66 / F
  • Chief ComplaintAn incidental finding of a lung mass
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Pulmonary sequestration, intralobar type
Radiologic Findings
Figure 1: Chest posteroanterior (PA) radiograph demonstrates a mass-like lesion in the right lower lobe.
Figures 2-5: CT scans reveal a large mass-like lesion in the right lower lobe, characterized by peripheral and septal enhancement, as well as internal low-density areas.
Figure 6: Coronal CT image shows a systemic supplying artery originating from the aorta.
Figure 7: PET/CT reveals that the majority of the lesion appears as a photon defect, with mild uptake observed at the lateral periphery.
Brief Review
Pulmonary sequestration (PS) is a congenital lung malformation that consists of a nonfunctioning lung tissue with no apparent communication with the tracheobronchial tree. The blood supply to PS is through aberrant vessels from systemic circulation, most commonly the descending thoracic aorta.
The PS is divided into two types, intralobar sequestration (ILS) which is the more common type, where the lesion lies within pleural layer surrounding the lobar lung and extralobar sequestration (ELS) which has its own pleural covering, maintaining complete anatomic separation from adjacent normal lung.
Most patients with ILS present in adolescence or early adulthood with recurrent pneumonias in the affected lobe. Patients with PS can be asymptomatic and the diagnosis achieved incidentally. Other presenting symptoms may include cough, hemoptysis, chest pain and dyspnea. ELS rarely becomes infected because it is separated from the tracheobronchial tree by its own pleural investment.
There are multiple radiologic manifestations of PS on computed tomography (CT) which include mass, consolidation with or without cysts, bronchiectasis and cavitary lesions. Hyperlucency can be seen in ILS due to the entrance of air from the collateral drift from normal lung resulting in air trapping.
The arterial supply to PS is most commonly from the thoracic aorta as described for 74% of cases reported by Savic et al. in a review of 540 published cases. The supplying artery may also arise from the abdominal aorta, celiac artery, splenic artery or even a coronary artery. Most ILS drains to pulmonary veins while venous drainage for most ELS is to the azygos or hemiazygos vein or to the inferior vena cava.
References
Alsumrain, M., Ryu, J.H. Pulmonary sequestration in adults: a retrospective review of resected and unresected cases. BMC Pulm Med 18, 97 (2018). https://doi.org/10.1186/s12890-018-0663-z
Keywords

No. of Applicants : 61

▶ Correct Answer : 41/61,  67.2%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - Other , Korea (South) BYUK GYUNG CHOI
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - Other , Korea (South) HYEJOO PARK
  • - , Japan YOSHIKI ISHII
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Korea (South) HEONSEOK LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Albania AN G
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - GHICL , France MANUEL TOLEDANO
  • - TB centre kasaragod. , India rikhy krishnan
  • - , Taiwan SHIHHAN PAN
  • - The First Affiliated Hospital of Nanjing Medical University , China TENG ZHANG
  • - Kyoto University , Japan SHO KOYASU
  • - , Japan SHUHEI NORIMOTO
  • - Fukuoka university , Japan KEISUKE SATO
  • - , Japan YUMI MAEHARA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 4/61,  6.6%
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
▶ Semi-Correct Answer : 1/61,  1.6%
  • - Other , Korea (South) CHAEHUN LIM
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