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