Pulmonar sequestration case report
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A 59-year-old male smoker presented with recurrent attacks of blood-tinged sputum over 12 years. Imaging revealed a right lower lobe opacity and calcification. Further CT angiography identified a right intralobar pulmonary sequestration (ILS) receiving a dual arterial blood supply from the right pulmonary artery and abdominal aorta, with venous drainage into the right pulmonary vein. Pulmonary sequestration is a congenital malformation where non-functioning lung tissue receives a blood supply directly from the systemic circulation instead of the pulmonary arteries. Surgical resection is typically recommended to prevent infections, though recent options include video-assisted thoracoscopic surgery or arterial embolization of feeding vessels.
Pulmonar sequestration case report
- 2. Case description • Male patient 59 years old.Male patient 59 years old. • Current smoker.Current smoker. • Presented with recurrent attacks of bloodPresented with recurrent attacks of blood tinged sputum (average 3 attacks/ year).tinged sputum (average 3 attacks/ year). • First attack started 12 years ago.First attack started 12 years ago.
- 3. Case description • The patient was first investigated in the primary health care facility where chest X- ray was done. • He was diagnosed as a case of bronchitis despite the obvious right paracardiac opacity.
- 4. Chest X ray Right paracardiac shadow
- 5. Case description • The patient was treated with non specific treatment. • patient was admitted to a general hospital due to another attack of hemoptysis with syncope. • Thorax CT scan: o Right lower lobe opacity with calcification.
- 6. CT of the chest Right lower lobe opacity with calcification
- 7. Case description • Due to the suspicious of malignancy: ultrasonographic-guided aspiration was done twice. • Pathological examination: o Fibrous tissue with dilated vascular spaces.
- 8. Case description • The patient was referred to the chest department at the Mansoura university hospital for further evaluation and bronchoscopy. • After revision of the history and chest radiology, pulmonary sequestration was suspected besides other benign lung lesions.
- 9. Case description • CT angiography: o Right intralobular pulmonary sequestration. o Dual arterial supply from right pulmonary artery and multiple branches from abdominal aorta. o The venous drainage into right pulmonary vein.
- 10. CT angiography Dual arterial supply from right pulmonary artery and multiple branches from abdominal aorta.
- 12. Pulmonary sequestration (PS) • Congenital lung malformation: o A mass of abnormal, nonfunctioning pulmonary tissue o No communication with tracheobronchial tree o Receive blood supply from an anomalous systemic artery (instead of pulmonary arterial system) o Usually occur in the left lower lobe
- 13. Types of PS Intralobar PS 75% Within visceral pleura of a pulmonary lobe Diagnosis is usually done at the second decade of life. Recurrent infection is common. Not associated with other anomalies Extralobar PS 25% Accessory lobe : tissue has its own pleura Diagnosis is usually made in neonates or infants. Often asymptomatic Often associated with other anomalies: • Diaphragmatic hernia •Cardiac malformation •Foregut anomalies
- 14. Types of PS Intralobar PS PS has visceral pleura of a lung lobe Extralobar PS PS has its own pleura
- 15. Types of PS Intralobar PS Cystic changes and infection are common Extralobar PS Infection is less common
- 17. CT angiography • Simultaneously visualize: oArterial supply. oVenous drainage. oParenchymal involvement of PS.
- 18. MRI • Demonstrates: oLocation of the lesion. oAberrant artery and venous drainage.
- 19. MRA Extralobar PS. Arrows referred to Aberrant blood supply.
- 20. Management
- 21. Management • Symptomatic patient: o Surgical resection with proper identification and ligation of the feeding vessels.
- 22. Management • Asymptomatic patient: o Surgery is recommended. • Prevent recurrent infections and the unfavorable cardiac influence caused by the existing aortopulmonary shunt.
- 23. Management • Recent modalities: 1. Video-assisted thoracoscopic surgery (VATS). 2. Arterial embolization of the feeding vessels.
- 24. Conclusion
- 25. • The interesting points in our case o The late presentation of the patient (59 years old) o Unusual right-sided ILS o The double blood supply from both pulmonary artery and abdominal aorta. Conclusion
- 26. Acknowledgments