Aberrant Systemic Arterial Supply Research Articles

Endovascular embolization for pulmonary sequestration in adults: An adjunctive technique to delay surgical intervention

Pulmonary sequestration is a congenital malformation characterized by a non-functioning segment of dysplastic lung that lacks communication with the bronchial tree and contains an aberrant systemic arterial supply. Pulmonary sequestration is classically managed surgically; however, surgical intervention is not always feasible on an emergent basis. We present two cases, in support of recent literature, that reinforce the use of transcatheter embolization to achieve hemostasis and delay surgical intervention.

Pulmonary sequestration presenting as a massive haemoptysis in adult: A case report.

IntroductionPulmonary sequestration is a rare congenital lung malformation characterized by non-functioning mass of pulmonary tissue that lacks normal communication with bronchial tree and receives one or more aberrant systemic arterial supply. It usually presents in children with recurrent chest infections. It is uncommon in adult and remains asymptomatic or present with recurrent chest infections, rarely with more severe symptoms like a massive haemoptysis as in seen in our case.Case presentationA 22-year-old male presented with a chief complain of multiple episodes of massive haemoptysis. After evaluation with chest x-ray, CT chest and angiogram, he was diagnosed to have intralobar pulmonary sequestration. He underwent successful thoracotomy and left lower lobectomy. He is asymptomatic after one year of follow up.DiscussionPulmonary sequestration is rare in adult and can present with various symptoms like chest pain, cough, sputum production, recurrent infection and rarely haemoptysis. Intralobar sequestration of left lower lobe is the most common as seen in our case. The diagnosis can be made by Computed Tomogram chest with angiogram. Surgical intervention is the definitive curative treatment. Post-operative outcome is excellent with early patient satisfaction and promising outcome in long term follow-up.ConclusionBronchopulmonary sequestration can rarely present in adults presenting with massive haemoptysis. CT chest is the best modality for diagnosis. Early surgical intervention is definitive treatment with good long term outcome.

The aberrant systemic-pulmonary artery communication: three-dimensional image simulation

BackgroundCongenital arterial abnormalities are unusual causes of hemoptysis in elder patients. Appropriate image examination and recognition of the variant vessels are crucial in achieving precise diagnosis and successful treatment.Case presentationWe report a case of 70-year-old female presenting with hemoptysis. Computed tomography angiography showed hypervascular lesions in the lingula of the left lung abutting the pericardium. Three-dimensional reconstruction image revealed an aberrant systemic arterial supply communicating with the left pulmonary artery and co-supplying the pulmonary parenchyma of the left upper. Single-port video-assisted thoracoscopic surgery with anomalous vessel ligation and lingual segmentectomy were performed smoothly. The symptom of hemoptysis subsided after operation with 2-year follow up.ConclusionAn anomalous systemic arterial supply to the left upper lobe of the lung with an aberrant systemic system draining into the left pulmonary artery and co-supplying the lung parenchyma is extremely rare. Preoperative simulation with three-dimensional reconstruction image provides a clear spatial anatomy that allows clinicians to identify the orientation of the vessels more precisely when deciding on intervention.

Unusual presentation of an intralobar pulmonary sequestration with recurrent haemoptysis, associated with aspergillosis

Intralobar pulmonary sequestration presenting with recurrent hemoptysis in association with aspergillosis is uncommon. Demonstration of the aberrant systemic arterial supply by computerized tomography (CT) angiogram is the key in establishing the diagnosis. A patient is reported with intralobar pulmonary sequestration in the left lower lobe and colonization of the sequestrated lung by aspergillosis, who presented with recurrent hemoptysis. The patient was treated successfully by lower lobectomy and leading a normal life 3 years after surgery.

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

Transarterial Embolization Treatment for Aberrant Systemic Arterial Supply to the Normal Lung: A Case Report and Literature Review

A minimal invasive surgical alternative to aberrant systemic arterial supply: Coil embolization

We present the case of a 20-year-old man with hemoptysis for 3 years. Chest radiography revealed increased pulmonary vascular opacities in the left lower lung field. Computed tomography showed an anomalous systemic artery arising from descending aorta supplying the basal segments of the left lower lobe. Bronchial tree was normal. Pulmonary artery angiogram revealed a hypoplastic inferior lobar branch of the left pulmonary artery. There was no direct communication between anomalous artery and pulmonary veins. We diagnosed our case as aortopulmonary collateral with normal lung parenchyma. Coil embolization of the anomalous systemic artery was performed. The patient survived well without evidence of hemoptysis for 18 months after coil embolization.

Resection of intralobar pulmonary sequestration after coil embolization of aberrant arteries: report of a case

Pulmonary sequestration describes a rare congenital mass of nonfunctional pulmonary tissue with an aberrant systemic arterial supply. Conventionally, the mass is removed surgically, but this carries a risk of serious and potentially fatal hemorrhage from the aberrant arteries during the operation. We describe how we performed coil embolization of the aberrant arteries immediately before surgery to overcome this problem. Coil embolization is safe, feasible and effective in preventing intraoperative bleeding. This case is reported to introduce a new preoperative procedure for pulmonary sequestration.

Anomalous Systemic Artery to a Normal Lung: A Rare Cause of Hemoptysis in Adults

Bronchopulmonary sequestration represents a spectrum of abnormalities. One of these abnormalities is an aberrant systemic arterial supply to a normal lung with no bronchial sequestration. These lesions were originally classified by Pryce as type 1. Most of these patients are asymptomatic but with time, many patients develop localized pulmonary hypertension, hemoptysis, and eventually high output cardiac failure. Multidetector computed tomography (MDCT) plays an important role in the diagnosis and planning of definitive treatment by identifying the origin and course of the aberrant artery. Definitive treatment can be surgical (lobectomy or segmentectomy) or endovascular.

Evaluation of diagnostic accuracy of computed tomography to assess the angioarchitecture of pulmonary sequestration

Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient underwent angiography with embolization using. Computed tomography especially multidetector computed tomography is a powerful noninvasive technique for the detection of pulmonary sequestration.

Therapeutic embolization of systemic arterial supply to normal basal segments of the left lower lobe of the lung

Systemic arterialization of normal lung without sequestration is a rare congenital abnormality. The basal segments of the left lower lobe are most frequently involved. The involved lung has no structural abnormalities of the tracheobronchial tree that distinguish this abnormality from bronchopulmonary sequestration. Haemoptysis and exertional dyspnoea are common presenting symptoms. We report the case of a 26-year-old man who presented with recurrent haemoptysis due to systemic arterialization of basal segments of the left lower lobe of the lung, without sequestration. Therapeutic embolization using metallic coils was successfully performed without any complications. There was no further haemoptysis during a 6-month follow up. Therapeutic embolization is a safe and effective method of managing the haemoptysis associated with aberrant systemic arterial supply to the normal lung.

Abstract No. 306 EE: Therapeutic Embolization of Aberrant Systemic Arterial Supply to Lungs: Review of the Spectrum and Approach to Therapy

Systemic arterial supply to the lungs can be seen in a spectrum of congenital or acquired disease. It can present with varied clinical manifestations or be diagnosed incidentally. Although conventional approach to therapy has been surgical, there have been early reports of therapeutic embolization of systemic arterial supply in form of sequestration in infants and neonates. In this article we will present cases of therapeutic embolization of systemic arterial supply in adults that presented with massive hemoptysis, which are among the first reported cases in literature.

Percutaneous ultrasound‐guided sclerotherapy for complicated fetal intralobar bronchopulmonary sequestration

Bronchopulmonary sequestration (BPS), which can be intralobar or extralobar, is a rare developmental anomaly of the lung characterized by nonfunctional pulmonary tissue without communication with the tracheobronchial tree and with an aberrant systemic arterial blood supply. The intralobar type is typically within the pleural cavity with an arterial feeding vessel generally arising from the thoracic aorta and with venous drainage into the left atrium. The prognosis is poor in cases diagnosed before 26 weeks' gestation and when there is mediastinal shift, polyhydramnios and fetal hydrops. The ideal prenatal management option remains undefined. We present a series of three complicated cases of intralobar BPS treated prenatally with percutaneous ultrasound-guided fetal sclerotherapy (FST). The feeding vessel was successfully accessed percutaneously under ultrasound guidance in all cases. FST with polidocanol resulted in complete obliteration of the blood flow to the mass. Abnormal Doppler findings, ascites, hydrops and polyhydramnios resolved and all patients were delivered at term. Antenatal treatment of patients with complicated BPS can be successfully achieved with FST, which is a simple and inexpensive technique. Comparison of risks and benefits of this approach with other techniques is warranted.

Multidetector CT Angiography in Pulmonary Sequestration

To evaluate the role of multidetector CT angiography in the diagnosis and preoperative assessment of pulmonary sequestration with angiographic or surgical correlation. Eight patients (5 males, 3 females) in the age range of 2 days to 35 years suspected of having pulmonary sequestration on the basis of clinical history and chest radiographs were included in the study. All patients underwent CT angiography (4 or 16 slice) and MPVR, MIP and 3D volume rendered images were generated. The axial images were also reviewed at soft tissue and lung window settings to evaluate the parenchymal changes. CT angiography showed five pulmonary sequestrations on the left and three on the right, located in the basal segments (n = 7) or paravertebral region (n = 1). Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n = 2); abdominal aorta (n = 3) and celiac axis (n = 3). Venous drainage into inferior pulmonary veins was demonstrated in 4 patients. The angioarchitecture depicted on CT angiography was confirmed on surgery in five patients and by DSA in two patients who subsequently underwent embolization using PVA particles and/or coils. The ability of CT angiography to simultaneously image the arterial supply, venous drainage and parenchymal changes in a single examination makes it the imaging modality of choice for the diagnosis and preoperative assessment of pulmonary sequestration.

Ventilation???Perfusion Mismatch Resulting From an Aberrant Systemic Arterial Supply to Basal Segmentsof the Right Lung

A 30-year-old woman was referred for ventilation-perfusion scintigraphy to assess the cause of massive hemoptysis. Scintigraphy showed large segmental ventilation-perfusion mismatched defects in the superior, and lateral and posterior basal segments of the right lower lobe. High-resolution computed tomography was negative for pulmonary embolism. Bronchial angiography demonstrated an arterial malformation between the bronchial and pulmonary arteries.

Lessons to be learned: a case study approach Carcinoid tumourlets associated with diffuse bronchiectasis and intralobar sequestration

Innumerable carcinoid tumourlets may develop within pulmonary lobes should there be scarring from intralobar sequestration; these tumourlets may, in turn, be the cause of chronic lung disease. This report documents the incidental detection of multifocal carcinoid tumourlets in the lung of a 65-year-old man who had repeated episodes of lung infection, progressive dyspnea and haemoptysis; he lived at high altitude. The left lower lobe of the lung was resected surgically, during which procedure an aberrant systemic arterial supply was noticed. The patient had diffuse bronchiectasis and intralobar sequestration. The latter implies the development of abnormal lung tissue located within lobar tissue--but which does not communicate with the bronchial tree; it is supplied with arterial blood from a branch of the aorta--arising either above or below the diaphragm. There was loss of demarcation between the sequestered lung and the surrounding lower lobe lung parenchyma. The proliferation of pulmonary neuroendocrine cells in the form of tumourlets, had probably occurred as an adaptive response to the chronic hypoxia experienced. The combination of intralobar sequestration, bronchiectasis and carcinoid tumourlets, although uncommon, may arise when intralobar sequestration of the lung has not been resected at an incipient stage.

Aberrant systemic arterial supply to the left lung with congestive heart failure: S. M. Yabek, J. Burstein, W. Berman, Jr., et al. Chest 80:636–637, (November), 1981

Aberrant systemic arterial supply to the left lung with congestive heart failure: S. M. Yabek, J. Burstein, W. Berman, Jr., et al. Chest 80:636–637, (November), 1981

Aberrant Systemic Arterial Supply to the Left Lung with Congestive Heart Failure

A six-month-old girl with an aberrant systemic arterial supply from the descending thoracic aorta to the left lower lobe had congestive heart failure. Although the pulmonary parenchyma was normal, there was an absence of normal pulmonary arterial supply to the left lower lobe. Main pulmonary arterial and aortic cineangiograms led to the correct diagnosis. Left lower lobectomy was performed and resulted in clinical and hemodynamic improvement.

Regional Pulmonary Function in Scimitar Syndrome

Analysis of regional pulmonary function distribution using radioactive 133xenon gas and eight scintillation detectors was performed in a patient with scimitar syndrome. Zonal ventilation per unit of lung volume within the slightly hypoplastic right lung was normal. The pulmonary blood flow to the lower right zone was significantly reduced due to aberrant systemic arterial supply to the right lower lobe. The 133xenon technique provides a simple nontraumatic method of evaluating the functional integrity of the right lung in this cardiopulmonary syndrome.

Intralobar pulmonary sequestration in association with bilateral systemic arterialization of the lungs.

Over 250 cases of intralobar pulmonary sequestration have now been reported (Ranniger and Valvassori, 1964). The diagnosis which may be suspected on the clinical, plain radiographic and bronchographic findings, depends on the angiographic or operative demonstration of an aberrant systemic arterial supply to the affected segment. The preoperative angiographic visualization of this pulmonary systemic arterialization arising from the thoracic or abdominal aorta either as a single large vessel (McDowell, Robb and Indyk, 1955) or as multiple small arteries (Turk and Lindskog, 1961) to a large extent eliminates the operative hazards (Harris and Lewis, 1940). This paper reports an unusual case of pulmonary intralobar sequestration in association with bilateral aberrant systemic arteries. The angiographic and operative findings suggest that this may be a case of bilateral pulmonary squestration. D.M., a boy aged four-and-a-half years, was admitted to the University Hospital of the West Indies for investigation of...