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Case No : 1185 Date 2020-07-09

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  • Courtesy of Bo Mi Gil, Myung Hee Chung / Bucheon St. Mary's Hospital, The Catholic University of Korea
  • Age/Sex 45 / M
  • Chief Complaintgeneral weakness and hemoptysis / onset: several days ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Intralobar pulmonary sequestration with reactivated tuberculosis
Radiologic Findings
Figure1. Chest PA shows multiple variable sized, calcific and noncalcific nodules in both upper lobes. There is also a well demarcated mass with air fluid level in the left retrocardiac region.
Figure 2-5. Chest enhanced CT scans show multiple well-circumscribed nodules with marginal, thin-rim enhancement and a cavity in both upper lobes.
Figure 6-7. Feeding artery(arrows) is arised from descending thoracic aorta, and traverses through solid inhomogenous mass, which drains to the left pulmonary vein in left lower lobe.

Figure 6.

Figure 7.

Brief Review
Pulmonary sequestration is a rare congenital pulmonary disorder with an incidence rate of approximately 0.1%. According to some journals, it occurs slightly more in males. It is defined as an area of dysplastic and non-functioning pulmonary tissue with an anomalous systemic blood supply. It has been classically described in two forms: intralobar sequestrations located within the visceral pleura and surrounded by normal lung, and extralobar sequestrations which have a separate pleural covering. There is no communication with the tracheobronchial tree. In the vast majority of cases, the abnormal lung tissue is supplied by an artery which is usually a branch of the aorta.

CT shows the arterial supply originating from the descending aorta. Intralobar bronchopulmonary sequestration affects the lower lobes in 95% of cases and the middle or upper lobes in 2% of cases. Intralobar bronchopulmonary sequestration most commonly presents as either a well-defined homogeneous opacity in the lung base or a solitary lung nodule. Air
Please refer to
Case 12, Case 31, Case 214, Case 417, Case 689,
References
1) Ko SF, Ng SH, Lee TY et-al. Noninvasive imaging of bronchopulmonary sequestration. AJR Am J Roentgenol. 2000;175 (4): 1005-12
2) Ikezoe J, Murayama S, Godwin JD, Done SL, et al. Bronchopulmonary seqeustration: CT assessment, Radiology. 1990 Aug;176(2):375-9
3) Franco J, Aliaga R, Domingo ML, et al.Diagnosis of pulmonary sequestration by spiral CT angiography. Thorax 1998;53:1089-1092.
4) Berrocal T, Madrid C, Novo S et-al. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics. 24 (1): e17.
Please refer to
Keywords
lung, Pulmonary tuberculosis, Pulmonary Sequestration,

No. of Applicants : 65

▶ Correct Answer : 3/65,  4.6%
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - The Jikei university , Japan TAKU GOMI
▶ Correct Answer as Differential Diagnosis : 21/65,  32.3%
  • - , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Senegal AXEL MBUYU KAYEMBE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Other , Korea (South) JIYEON HAN
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) CHAEHUN LIM
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
▶ Semi-Correct Answer : 6/65,  9.2%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Samsung Medical Center , Korea (South) CHOHEE KIM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
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