Case description

• Male patient 59 years old.Male patient 59 years old.

• Current smoker.Current smoker.

• Presented with recurrent attacks of blood Presented 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.

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.

Chest X rayRight paracardiac shadow

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.

CT of the chestRight lower lobe opacity with calcification

Case description

• Due to the suspicious of malignancy:

ultrasonographic-guided aspiration was done twice.

• Pathological examination:o Fibrous tissue with dilated vascular spaces.

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.

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.

CT angiographyDual arterial supply from right pulmonary artery and multiple branches

from abdominal aorta.

Pulmonary sequestration

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

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

Types of PS

Intralobar PSPS has visceral pleura of a lung lobe

Extralobar PSPS has its own pleura

Types of PS

Intralobar PSCystic changes and infection are

common

Extralobar PS

Infection is less common

Radiological assessment

CT angiography

• Simultaneously visualize:

oArterial supply.oVenous drainage.oParenchymal involvement of PS.

MRI

• Demonstrates:

oLocation of the lesion.oAberrant artery and venous drainage.

MRAExtralobar PS. Arrows referred to Aberrant blood supply.

Management

Management

• Symptomatic patient:

o Surgical resection with proper identification and

ligation of the feeding vessels.

Management

• Asymptomatic patient:

o Surgery is recommended.• Prevent recurrent infections and the unfavorable

cardiac influence caused by the existing aortopulmonary shunt.

Management

• Recent modalities:

1. Video-assisted thoracoscopic surgery (VATS).

2. Arterial embolization of the feeding vessels.

Conclusion

• 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

Acknowledgments