Albera, Carlo

Ardissone, Francesco

Borasio, Piero

Cardinale, L

Lausi, Paolo Olivo

English

Institutional Research Information System University of Turin

JBR–BTR, 2008, 91: 24.IMAGES IN CLINICAL RADIOLOGY1. Thoracic Surgery Unit, 2. Radiology Unit, 3. Respiratory Medicine Unit,University of Turin, Department of Clinical & Biological Sciences, San LuigiHospital, Orbassano, Turin, Italy.Three-dimensional demonstration of sys-temic blood supply to normal left basalsegmentsP. Borasio1, L. Cardinale2, P. Lausi1, C. Albera3, F. Ardissone1A 20-year old non-smoker man presented with a 2-month histo-ry of episodic blood streaking of the sputum. Physical examinationrevealed decreased breath sounds and a continuous bruit in theleft lower lung field. Chest radiography showed a retrocardiacvessel-like opacity with focal obliteration of the descending aorticinterface and increased vascular shadows in the left lower lobe(Fig. A, arrows). Computed tomographic scan on lung windowsetting demonstrated dilated peripheral branches of the aberrantartery and increased attenuation of involved segments (Fig. B).Three-dimensional computed tomography clearly showed theanomalous artery arising from the lower thoracic aorta (Fig. C,black asterisks). Venous return was via the inferior pulmonary veininto the left atrium. The patient had no evidence of left ventricularoverload or pulmonary hypertension. Pulmonary function testsand arterial blood gas tensions were normal. Bronchoscopydisclosed no abnormality.At surgery, the anomalous artery, 2 cm in diameter, was suturedflush to the thoracic aorta using an Endo-GIA stapling device anddivided. Then, a basal segmentectomy was performed, sparingtwo pulmonary arterial branches which supplied the superior seg-ment of the lower lobe (Fig. C, white star). Pathologic examinationof the resected specimen did not identify any sequestrated lung.The patient had an uncomplicated postoperative recovery, andremains well 5 years after surgery.CommentAnomalous systemic arterial supply to the normal lung is a rarevariant of the sequestration (or malinosculation) spectrum, whichincludes a wide range of congenital anomalies of the broncho-pulmonary airways and related vasculature. These lesions can beclassified according to their abnormal anatomical component(s):tracheobronchial airway, lung parenchyma, arterial supply, andvenous drainage. Indeed, the striking clarity with which the aber-rant systemic arterial supply to an area of otherwise normal lungwas shown on the three-dimensional reconstruction emphasizesthe potential of this technique for a prompt understanding ofunusual anatomy.ABC

Three-dimensional demonstration of systemic blood supply to normal left basal segments

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Three-dimensional demonstration of systemic blood supply to normal left basal segments

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