Diagnosis of pulmonary sequestration by spiral CT angiography

Abstract

The common feature of the reports by Franco et al 1 and Oliver et al 2 is the use of spiral (or volumetric) computed tomography to demonstrate features which would not be readily identifiable on conventional computed tomographic (CT) scanning. The advantages of spiral CT over conventional CT scanning are twofold: increased speed of data acquisition and volumetric (rather than slice by slice) data acquisition. The attribute of speed means that most thoracic examinations can be performed within a single breath hold and the timing of intravenous contrast administration can be precisely tailored, thus allowing reproducible enhancement of any desired part of the vasculature-for example, the pulmonary arteries in cases of suspected pulmonary embolism. Because an entire volume of data is acquired (with almost equal spatial resolution in the three axes) it is possible to reconstruct images in any plane, including threedimensional (3-D) reconstructions.3 Most examinations acquired with spiral CT scanning are presented as a series of transaxial slices, reflecting the traditional presentation of conventional CT images.In the report by Franco et al 1 the clarity with which the anomalous arteries feeding the sequestrated lung are shown on the 3-D reconstructions is striking. In the past a separate preoperative examination (either aortography or possibly magnetic resonance angiography) to identify the vascular supply would have been regarded as mandatory. Other imaging tests such as radionuclide scintigraphy or ultrasound may answer specific questions in cases of pulmonary sequestration, but the wealth of information now available from a single spiral CT examination is remarkable. Quite apart from their aesthetic appeal, the main benefit of these readily produced 3-D reconstructions is an easy appreciation of what can be complex anatomy. Nevertheless, claims for the increased diagnostic gain from these 3-D reconstructions should not be too extravagant: the anomalous vessels would be identifiable on images presented in the standard transaxial format, although without such immediacy. Furthermore, demonstration of the venous drainage into the pulmonary circulation (for the classic intralobar sequestrations) may not be so readily obtained with a single spiral CT examination. However, the ability to extract so much information from a spiral CT examination represents a substantial advance on conventional CT scanning. Spiral CT pulmonary angiography is an eVective way of demonstrating pulmonary embolism in segmental and larger arteries. 4 The basic sign of a filling defect within a well opacified pulmonary artery is straightforward enough. The case report by Oliver et al 2 highlights the fact that there may be ancillary signs of pulmonary embolism on spiral CT scanning-in this case shift of the interventricular septum-which corroborates the diagnosis and, more controversially, provides prognostic information. Shift of the interventricular septum and other signs of right ventricular dysfunction are readily demonstrated on echocardiog...

Extralobar pulmonary sequestration diagnosed intraoperatively in a 37 year-old male with bullous lung disease

“…Intralobar sequestrations usually drain into pulmonary veins; extralobar sequestrations usually drain into the azygos system. [5] ELS is more likely than ILS to be associated with anomalies, including congenital diaphragmatic hernia or eventration, cardiac defects, and foregut anomalies. [6] Clinically, PS is usually latent until infection leads to symptoms.…”

A Case Of Intrapulmonary Sequestration Seeming As An Intrathoracic Mass

“…Pre-operative identification of the aberrant arterial supply is important in preventing operative morbidity. Spiral CT and magnetic resonance angiography (MRA) are the imaging method of choice for identifying the aberrant artery and the venous return 8,9 . The arterial supply of intralobar sequestration is a branch off of the thoracic aorta in up to 75% of patients.…”

Chest Including Lungs and Mediastinum

“…Typical CT appearance consists of an area of consolidation or cystic space in lower hemithorax (Ko et al 2000 ). The identifi cation of a supplying separate branch of aorta is essential for diagnosis which be made on CT angiography ( Franco et al 1998 ) (Fig. 12.61 ).…”