A case of systemic arterial supply to the right lower lobe of the lung: imaging findings and review of the literature

Abstract

Systemic arterialization of the lung without pulmonary sequestration is the rarest form of anomalous systemic arterial supply to the lung. This condition is characterised by an aberrant arterial branch arising from the aorta which supplies an area of lung parenchyma with normal bronchopulmonary anatomy. It is often diagnosed following investigation of an incidental cardiac murmur or based on abnormal imaging, as most patients are asymptomatic or minimally symptomatic. Thoracic computed tomography and computed tomography angiography are generally the most useful diagnostic tests. We present a case of a 22-year old female who was diagnosed with systemic arterial supply to a portion of otherwise normal right lower lobe following investigation of low volume haemoptysis.

Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

“…Venous drainage is most commonly via pulmonary veins. The majority of patients are asymptomatic, however recurrent pulmonary infection, cardiac failure due to left-to-left shunt and haemoptysis are possible clinical presentations [2] , [3] .…”

“…Thoracic CTA is the most useful test in the evaluation of patients with suspected abnormal systemic arterial supply to the lung, as it demonstrates both the bronchial and vascular anatomy of the lung. Computed tomography may reveal a focal area of ground glass density, indicating an area of relative hypervascularity and/or intra-alveolar haemorrhage [2] , [3] . However, magnetic resonance imaging (MRI) or angiography can also be used to demonstrate aberrant vasculature and bronchial anatomy.…”

“…However, magnetic resonance imaging (MRI) or angiography can also be used to demonstrate aberrant vasculature and bronchial anatomy. Chest radiography is not pathognomonic and may reveal a pneumonia-like pulmonary consolidation or a soft tissue mass with well defined edges and air-fluid levels [1] , [2] , [3] .…”

“…Diagnosing ILS is based on imaging and identifying the systemic arterial supply. Haemoptysis and/or recurrent infections are present in two-thirds of patients [2] , [3] . The classical therapeutic approach is surgical resection in which the abnormal lung tissue is removed thus giving no opportunity for complications like ischemic infarction or abscess formation [4] , [5] .…”

Anomalous systemic arterial supply to the left lower lobe without evidence of pulmonary sequestration

“…Systemic arterial supply from the descending thoracic aorta to the basal segment of the left lower lobe is a rare congenital anomaly within the spectrum of pulmonary sequestration . CT of the chest is the most useful diagnostic test as it demonstrates both the bronchial and vascular anatomy of the lung, and CT angiography can clearly demonstrate the origin of the aberrant systemic artery .…”