Korean J Radiol.  2015 Jun;16(3):662-667. 10.3348/kjr.2015.16.3.662.

Extralobar Pulmonary Sequestration with Hemorrhagic Infarction in a Child: Preoperative Imaging Diagnosis and Pathological Correlation

• Choe J
• Goo HW

• KMID: 2155538
• DOI: http://doi.org/10.3348/kjr.2015.16.3.662

Abstract

We describe a rare case of extralobar pulmonary sequestration with hemorrhagic infarction in a 10-year-old boy who presented with acute abdominal pain and fever. In our case, internal branching linear architecture, lack of enhancement in the peripheral portion of the lesion with internal hemorrhage, and vascular pedicle were well visualized on preoperative magnetic resonance imaging that led to successful preoperative diagnosis of extralobar pulmonary sequestration with hemorrhagic infarction probably due to torsion.

Keyword

Extralobar pulmonary sequestration; Infarction; Children; MRI; CT; Ultrasonography

MeSH Terms

Abdominal Pain/etiology
Bronchopulmonary Sequestration/*diagnosis/surgery
Child
Fever/etiology
Humans
Magnetic Resonance Imaging/*methods
Male
Pulmonary Infarction/*diagnosis/surgery
Torsion Abnormality/complications

Figure

• 

  Fig. 1 10-year-old boy with extralobar pulmonary sequestration with hemorrhagic infarction. A. Left posterior sagittal chest ultrasonography using convex, low-frequency (3.5 MHz) transducer shows lentiform heterogeneous solid mass (arrowheads) with linear structures (arrow) in left lower hemithorax. Adjacent consolidated lung and large amount of left pleural effusion containing low-level echoes were also identified. B. Color Doppler ultrasonography demonstrates minimal vascularity in lesion. C. Axial T2-weighted image shows well-defined triangular solid mass lesion with left pleural effusion. Central branching cystic structure (arrow) within mass corresponded to dilated bronchiole on histopathologic examination. Hemiazygos vein (arrowhead) appears to be mildly dilated. D. Axial T1-weighted image reveals small artery arising from descending thoracic aorta (arrows) and connecting to lesion. E. Dynamic contrast-enhanced image demonstrates irregular central enhancement with several foci of poor enhancement (arrows) in periphery of lesion. Pleural enhancement is also noted. F. Cut section of excised lesion shows dark brown triangular mass with 0.5 cm-sized central tubular structure (arrow). Photomicrographs (G, H) show hemorrhagic infarction with ample red blood cells (G) and anomalous lung tissue with cartilages (asterisks in H) (hematoxylin and eosin stain, × 50).

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