Lingular intralobar pulmonary sequestration supplied by the left inferior phrenic artery arising from the left gastric artery – A case report and literature review

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Abstract

Pulmonary sequestration is characterized by a nonfunctional mass of lung tissue with an aberrant blood supply. Intralobar pulmonary sequestration (IPS) typically affects lower lung lobes and receives its blood supply from systemic arteries. Here, we present a unique case of a 51-year-old woman presented with recurrent nonmassive hemoptysis. Contrast-enhanced computed tomography angiography (CTA) of the chest showed uniform consolidation in the inferior lingular segment of the left upper lobe. Maximal intensity projection (MIP) and three-dimensional volume rendering (3D-VR) showed the affected area's blood supply from unusual arterial branches originating from the left inferior phrenic artery arising from the left gastric artery, consistent with IPS. A multidisciplinary approach utilized endovascular intervention (coil embolization) before successful surgical resection. Detecting IPS in unusual sites, like the lingular region, poses a diagnostic challenge. Clinicians and radiologists may not initially consider this diagnosis when evaluating patients with respiratory symptoms or incidental imaging findings. A comprehensive grasp of their anatomy and vascular variations is vital for precise diagnosis and effective treatment planning.

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Pulmonary sequestration: a retrospective analysis of 2625 cases in China.

Yong Wei, Fan Li (2011)

Pulmonary sequestration is a congenital lung malformation, which is often misdiagnosed as lung cancer, pulmonary cysts, mediastinal tumors, etc. Therefore, more research on the clinical characteristics of pulmonary sequestration should be carried out to improve the preoperative diagnosis rate. The study used was a retrospective analysis of 2625 cases of pulmonary sequestration well documented in the Chinese National Knowledge Infrastructure from 1998 to 2008. Analysis was performed on the patients' age, gender, symptom, chest computed tomography (CT) scan, chest radiograph, lesion localization, arterial supply, venous drainage, and incorrect preoperative diagnosis. A total of 2625 cases of pulmonary sequestration was reported in the Chinese National Knowledge Infrastructure from 1998 to 2008, and the male:female ratio was 1.58:1. The symptoms of pulmonary sequestration were cough, sputum, fever, hemoptysis, and chest pain, with 13.36% of patients being asymptomatic. Chest CT scan showed mass lesions (49.01%), cystic lesions (28.57%), cavitary lesions (11.57%), and pneumonic lesions (7.96%). The sequestration was mainly located in the lower lobe, primarily in the left posterior basal segment (66.43%) and in the right posterior basal segment (20.16%). Pulmonary sequestrations were divided into two types, intralobar sequestration (83.95%) and extralobar sequestration (16.05%). Bilateral sequestrations were rare--only three cases had been reported. The arterial supply was mainly provided by branches of thoracic aorta (76.55%) and abdominal aorta (18.47%). The mean incorrect preoperative diagnosis rate was as high as 58.63%. A comparison between pediatric and adult patients indicated that the subtype ratio (intralobar/extralobar) was higher in the adult group than that in the pediatric group (P < 0.001). Clinical manifestations of pulmonary sequestration varied and preoperative diagnosis was often incorrect. To improve the preoperative diagnosis rate, we should take full advantage of symptoms, image performance, and localization characteristics. A certain early-onset age, recurrent pneumonias, mass or cyst lesion located in the lower lobe, and aberrant arterial supply are indicators for the diagnosis. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

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Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology.

Teresa Berrocal, Carmen Madrid, Susana Novo … (2015)

Congenital anomalies of the chest are an important cause of morbidity in infants, children, and even adults. The evaluation of affected patients frequently requires multiple imaging modalities to diagnose the anomaly and plan surgical correction. The authors analyze and illustrate practical aspects of certain common and uncommon congenital anomalies affecting the tracheobronchial tree, lung, and mediastinum, with emphasis on radiologic manifestations. Other thoracic anomalies such as rib anomalies and vascular rings are discussed when they are associated with anomalies of the tracheobronchial tree. The usefulness of the various imaging modalities in the diagnosis and treatment of these conditions is also evaluated. Specific topics addressed include tracheal conditions such as tracheal stenosis, tracheomalacia, tracheal bronchus, tracheal atresia, and bronchogenic cyst; anomalies of the lung such as lung underdevelopment (agenesis and hypoplasia), scimitar syndrome, congenital cystic adenomatoid malformation, congenital lobar emphysema, and pulmonary sequestration; esophageal anomalies such as esophageal atresia, tracheoesophageal fistula, and esophageal duplications; and vascular rings. The embryologic and pathologic basis of the radiologic findings are discussed in appropriate cases. Differential diagnoses, as well as pitfalls and diagnostic difficulties, are included. Copyright RSNA, 2003

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Thoracoscopic treatment of pulmonary sequestration.

Walter Weder, Peter B Kestenholz, Didier Lardinois … (2006)

Pulmonary sequestration is a rare congenital malformation and may be the cause of recurrent infections or hemoptysis. It has been shown in case reports that resection by video-assisted thoracic surgery (VATS) is feasible despite the possible technical difficulties due to inflammatory changes, but its role has not been evaluated yet in a larger series of consecutively treated patients. Retrospective analysis of all consecutively thoracoscopically treated patients (between January 1991 and January 2005) with pulmonary sequestration in a single center. We included 14 patients in the study who fulfilled the criteria; seven were women. Median age was 33 years (20-64 years). The following data were analyzed for all patients: major symptoms, diagnostic procedures, treatment, and outcome. Operative parameters and findings including operating time, blood loss, anatomical location of the sequestration, and feeding vessels were evaluated. Leading symptoms were recurrent infections (10), hemoptysis (3), and chest discomfort (1). The diagnosis was made by CT scan. Additionally, an arteriography or an angio-MRI was done in three patients and one patient, respectively. Thirteen intralobar (all lower lobes, eight on the right) and one left-sided extralobar pulmonary sequestration were resected. We performed eight lobectomies, four atypical segmentectomies, one extralobar resection, and one occlusion of the aberrant artery. One case had to be converted to a thoracotomy due to bleeding from the aberrant artery. There was no mortality. Complications included pneumonia in three cases, one hemothorax, one pneumothorax after removing the chest tube, and one wound infection. All were treated conservatively. Thoracoscopic treatment of pulmonary sequestration is feasible in experienced hands. The aberrant systemic artery can be freed and dissected safely despite the frequently occurring inflammatory changes. Conversion rate to thoracotomy is low.

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Massupa Krisem

Journal

Journal ID (nlm-ta): Radiol Case Rep

Journal ID (iso-abbrev): Radiol Case Rep

Title: Radiology Case Reports

Publisher: Elsevier

ISSN (Electronic): 1930-0433

Publication date PMC-release: 15 December 2023

Publication date Collection: March 2024

Publication date (Electronic): 15 December 2023

Volume: 19

Issue: 3

Pages: 839-843

Affiliations

[a ]Department of Radiology, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand

[b ]Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand

[c ]Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand

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[* ]Corresponding author. massupa.k@ 123456hotmail.com

Article

Publisher Item ID: S1930-0433(23)00871-3

DOI: 10.1016/j.radcr.2023.11.047

PMC ID: 10770495

PubMed ID: 38188943

SO-VID: 4d3ea6ab-3858-4495-9c41-3f8ba2c44d7d

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Lingular intralobar pulmonary sequestration supplied by the left inferior phrenic artery arising from the left gastric artery – A case report and literature review

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Most cited references 20

Pulmonary sequestration: a retrospective analysis of 2625 cases in China.

Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology.

Thoracoscopic treatment of pulmonary sequestration.

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