Evaluation of pulmonary sequestration with multidetector computed tomography angiography in a select cohort of patients: A retrospective study

Abstract

OBJECTIVES:This study aimed to evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration.METHODS:We retrospectively analyzed the computed tomography studies and clinical materials of 43 patients who had undergone preoperative multidetector computed tomography angiography in our hospital and had pathologically proven pulmonary sequestration. Each examination of pulmonary sequestration was reviewed for type, location, parenchymal changes, arterial supply and venous drainage on two-dimensional and three-dimensional computed tomography images.RESULTS:Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% of intralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients.CONCLUSIONS:As a noninvasive modality, multidetector computed tomography angiography is helpful for making diagnostic decisions regarding pulmonary sequestration with high confidence and for visualizing the related parenchymal characteristics, arterial supply, and venous drainage features to help plan surgical strategies.

Intralobar pulmonary sequestration: incidental finding in an asymptomatic patient

“…CTA also provides better spatial resolution over other imaging techniques for the visualization of the aberrant arterial supply and lung parenchyma [5] . In a retrospective study analyzing the CTA of patients who had been diagnosed with pathologically proven PS, Long et al [12] found CTA correctly diagnosed 100% of the aberrant supplying systemic arteries and draining veins. These authors also found that 70% of intralobar PS were located in the left lower lobe of the lung and 30% were located in the right lower lobe.…”

Intralobar pulmonary sequestration originating from the intercostal arteries treated with surgical resection

“…8 Surgical resection is the classical therapeutic approach for patients with pulmonary sequestration in order to prevent recurrent pulmonary infections, massive hemoptysis, or other symptoms, but its value is debatable in asymptomatic patients. 9 Recently, improved access to interventional radiology treatment coupled with advances in the coil embolization technique has been reported as a minimally invasive surgical alternative to lobectomy 2,4,10,11 However, data of endovascular embolization in symptomatic adult patients is sparse and long-term efficacy and safety have not been reported. Furthermore, very few studies have compared the results of embolization and surgical resection and reported which treatment is better in adult patients.…”

Intralobar pulmonary sequestrations in adults

“…Currently, Multidetector computed tomography angiography (MDCT) is the modern method for detecting of pulmonary sequestration. There are two principle objectives of MDCT angiography for the investigation of a suspected case of pulmonary sequestration: Firstly, to confirm the presence of an anomalous systemic arterial supplying the sequestered lung and secondary to distinguish pulmonary sequestration from other lung opacities [16].Magnetic resonance imaging is very useful in demonstrating the aberrant arteries and underlying parenchymal changes [14]. Antenatal diagnosis of pulmonary sequestration can be made as early as 18 weeks of gestation by ultrasonography [17].…”