Anomalous systemic arterial supply to the basal segments of the lung presenting with a murmur

Abstract

A murmur was discovered on routine preschool physical examination of a 5 year and 7 month-old boy. A lower lobe lesion was detected by chest X-ray. Aortography demonstrated that a large systemic artery from the descending thoracic aorta supplied the basilar segments of the left lower lobe, which had no normal pulmonary arterial supply. A clinical diagnosis of intralobar sequestration of the lung was made, and left lower lobectomy was performed.

Pulmonary Intralobar Sequestration Accompanied by Aneurysm of an Anomalous Arterial Supply.

“…Pryce type I pulmonary sequestration is rarely seen, in contrast to types II or III (3, 4). As far as could be de termined, only 21 cases have been reported (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) in Japan, including the present case (Table 1). Six patients had anomalous arteries which were dilated after branching off from the systemic arterial supply (8,14,18,20,21), and only 2 of these (8) had an aneurysmal dilatation of the anomalous vessel.…”

Anomalous Systemic Arterial Supply to Normal Basal Segments of the Left Lower Lobe of the Lung: Therapeutic Implication

“…This anomaly should be suspected in pediatric patients who present with a continuous murmur or in the absence of known causes of left heart dilatation. The usual choice of treatment is division of the anomalous artery followed by resection of the involved lung lobe [Ishihara 1979;Yamanaka 1999]. Recently, Baek et al [2006] described an adolescent patient who had been treated with simple ligation without lung resection.…”

“…An anomalous systemic arterial supply to the basal segments of the left lung without sequestration in which the normal pulmonary arterial supply is absent is a rare congenital anomaly. This condition is usually asymptomatic in children but may be discovered following an incidental finding of a continuous chest murmur [Ishihara 1979] and left ventricular failure that has developed from a left-to-left shunt [Yabek 1981]. Patients with this anomaly usually have been treated with lobectomy [Ishihara 1979;Yabek 1981].…”

“…This condition is usually asymptomatic in children but may be discovered following an incidental finding of a continuous chest murmur [Ishihara 1979] and left ventricular failure that has developed from a left-to-left shunt [Yabek 1981]. Patients with this anomaly usually have been treated with lobectomy [Ishihara 1979;Yabek 1981]. We describe the case of an infant who presented with left heart failure that was caused by an abnormal systemic arterial supply as a single source to the left lower lobe of the lung that arose from the descending aorta.…”

Intralobar pulmonary sequestration (a nonentity?)

“…There are 22 reported cases of aberrant artery to normal lung in the English literature. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] These cases are summarized in table 3. Cases of congenital systemic to pulmonary arteriovenous fistulas are not included.…”