Tuberc Respir Dis.  2010 Jun;68(6):358-362. 10.4046/trd.2010.68.6.358.

Intralobar Pulmonary Sequestration Receiving Its Blood Supply from the Celiac Artery

• Jung KH
• Lee SH
• Lee JH
• Jo WM
• Shin C
• Kim JH

• KMID: 1458046
• DOI: http://doi.org/10.4046/trd.2010.68.6.358

Abstract

Intralobar pulmonary sequestration is a rare congenital lung anomaly. It is defined as a portion of nonfunctioning lung parenchyma that receives its blood supply from an anomalous systemic artery. Patients often present with chronic or recurrent pneumonia. A chest radiograph may show a cystic lesion with air-fluid levels in the lung base. A high index of suspicion is needed for a diagnosis. Surgical removal of a symptomatic intralobar pulmonary sequestration is generally the treatment of choice. Identifying the aberrant artery is a difficult problem when resecting a pulmonary sequestration. The thoracic and abdominal aortas are the most common origins for the abnormal blood supply. However, arterial supply from the celiac artery is quite rare. We present a case of intralobar pulmonary sequestration with the blood supply originating from the celiac artery.

Keyword

Respiratory System Abnormalities; Bronchopulmonary Sequestration; Celiac Artery

MeSH Terms

Aorta, Abdominal
Arteries
Bronchopulmonary Sequestration
Celiac Artery
Humans
Lung
Pneumonia
Respiratory System Abnormalities
Thorax

Figure

• 

  Figure 1 (A) Chest radiograph on admission showed a patchy consolidation in the left lower hemithorax. (B~D) CT scan of chest revealed irregularly shaped multiloculated cystic consolidation at superior segment and posterior basal segment of left lower lobe.

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  Figure 2 (A) CT angiogram showed the prominent aberrant feeder artery arising from the celiac artery (arrow). (B) Selective angiogram revealed a large abnormal artery supplying blood to vessels within the left lower lung, and it was from the celiac artery (arrow). (C) Gross specimen of resected pulmonary sequestration showed multi-cystic and fibrotic changes. (D) Histopathologic finding of pulmonary sequestration showed the bronchiole-like structure lined by ciliated columnar epithelium and systemic arteries with concentrically arranged elastic fibers (H&E stain, ×100).

Reference

1. Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev. 2004. 5:59–68.

2. Savic B, Birtel FJ, Tholen W, Funke HD, Knoche R. Lung sequestration: report of seven cases and review of 540 published cases. Thorax. 1979. 34:96–101.

3. Cho HM, Shin DH, Kim KD, Lee S, Chung KY. Clinicopathological correlation of intralobar pulmonary sequestration. Korean J Thorac Cardiovasc Surg. 2003. 36:356–362.

4. Kang M, Khandelwal N, Ojili V, Rao KL, Rana SS. Multidetector CT angiography in pulmonary sequestration. J Comput Assist Tomogr. 2006. 30:926–932.

5. Hirai S, Hamanaka Y, Mitsui N, Uegami S, Matsuura Y. Surgical treatment of infected intralobar pulmonary sequestration: a collective review of patients older than 50 years reported in the literature. Ann Thorac Cardiovasc Surg. 2007. 13:331–334.

6. Chien KJ, Huang TC, Lin CC, Lee CL, Hsieh KS, Weng KP. Early and late outcomes of coil embolization of pulmonary sequestration in children. Circ J. 2009. 73:938–942.

7. Yamaguchi M, Takahashi N, Maehara M, Suguro H, Koya Y, Akashiba T, et al. A case report of intralobar pulmonary sequestration with an anomalous artery originating from the celiac artery. Nihon Kokyuki Gakkai Zasshi. 2002. 40:261–264.

8. Matsumoto I, Saito H. Intralobar pulmonary sequestration with an aberrant artery originating from the celiac artery and communicating with the pulmonary artery. Nihon Kyobu Shikkan Gakkai Zasshi. 1996. 34:444–448.

9. Park JM, Oh BS. Intralobar plmonary sequestration with hemoptysis and hemothorax. Korean J Thorac Cardiovasc Surg. 2007. 40:708–710.

10. Madhusudhan KS, Das CJ, Dutta R, Kumar A, Bhalla AS. Endovascular embolization of pulmonary sequestration in an adult. J Vasc Interv Radiol. 2009. 20:1640–1642.

11. Lee GW, Kim DK, Na HS, Bae JY, Choi JH, Kim YK, et al. A case of pulmonary sequestration treated with arterial embolization. Tuberc Respir Dis. 2005. 58:68–72.

12. Hayasaka K, Saitoh T, Tanaka Y. Intralobar pulmonary sequestration receiving arterial supply from the superior mesenteric artery: a case report. Comput Med Imaging Graph. 2006. 30:135–137.

13. Yeoum MS, Kim TH, Kim DY, Jung SJ, Lee CB, Lee HJ, et al. A case of pulmonary sequestration supplied with left gastric artery. Tuberc Respir Dis. 2000. 48:550–555.

14. Lee DI, Shim JK, Kim JH, Lee HY, Yun YK, Chun KJ. Pulmonary sequestration with right coronary artery supply. Yonsei Med J. 2008. 49:507–508.