Radiology CME
Aberrant arterial supply to left lung Yasir Peringattuthodiyil, Devasahayam Jesudas Christopher, T Balamugesh, S Saheer Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
Address for correspondence: Dr. Yasir Peringattuthodiyil, Department of Pulmonary Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. E‑mail: [email protected]
Anomalous systemic arterial supply to normal segments of the lung is a rare congenital anomaly. Although the etiology of systemic arterial supply to normal lung is still unknown, it is generally believed that this might result from an abnormal persistence of the embryonic connection between aorta and pulmonary parenchyma.[1] This disease was previously classified as Pryce Type I sequestration.[2] However, the absence of parenchymal abnormalities with a normal bronchial supply distinguishes systemic arterial supply from true pulmonary sequestration.[3] Review of published literature search shows that the systemic arterial supply is not usually associated with other anomalies.[4] Symptoms of systemic arterialization of the left lower lobe without sequestration were variable. Most patients were asymptomatic. Hemoptysis seemed to be an unusual manifestation.[5] Computed tomography often detects the lesion [Figure 1] but gold standard of diagnosis is selective angiogram. Pathological examination of anomalous arteries documented that the walls had elastic laminae within their media, but not the muscular layer, unlike bronchial arteries. Such a wall may not withstand the high pressure of the systemic circulation. [6] This might explain the mechanism of hemoptysis in the anomalous systemic arterial supply to the normal lung.
recommended because of its propensity for recurrent infection.[4] However, in pulmonary sequestration, if the parenchyma is normal, as one might encounter in systemic arterialization to lung, only a ligation of the systemic vessel by surgical ligation or coil embolization [Figure 2] may be sufficient.[5]
Figure 1: Contrast CT thorax showing a single branch from the descending thoracic aorta supplying basal segments of the left lower lobe
Treatment is recommended for all patients diagnosed with this anomaly ‑ with or without symptoms, because of its potential risk for hemoptysis.[7] Treatment options utilized in case reports include: Simple ligation of aberrant systemic artery, anastomosis to the pulmonary artery or simple lobectomy.[8] In pulmonary sequestration, resection of the sequestrated lung parenchyma is Access this article online Quick Response Code:
Website: www.lungindia.com DOI: 10.4103/0970-2113.156257
Figure 2: Check angiogram performed post deployment showing non-opacification of the distal aberrant artery with Amplatzer II plug in place
Lung India • Vol 32 • Issue 3 • May - Jun 2015 287
Peringattuthodiyil, et al.: Aberrant arterial supply to left lung
REFERENCES 1. 2. 3. 4. 5.
288
Kirks DR, Kane PE, Free EA, Taybi H. Systemic arterial supply to normal basilar segments of the left lower lobe. AJR Am J Roentgenol 1976;126:817‑21. Pryce DM. Lower accessory pulmonary artery with intralobar sequestration of lung; a report of seven cases. J Pathol Bacteriol 1946;58:457‑67. Oermann CM. Bronchopulmonary sequestration. Available from: http:// www.uptodate.com. [Last accessed on 2014 Jan 12] 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. Brühlmann W, Weishaupt D, Goebel N, Imhof E. Therapeutic embolization of a systemic arterialization of lung without sequestration. Eur Radiol 1998;8:355‑8.
6.
7. 8.
Cheng WE, Chen CH, Tao CW, Chern MS, Yuen KH, Perng RP. Anomalous systemic arterial supply to normal basilar segments of the left lower lobe of the lung: A case report. Zhonghua Yi Xue Za Zhi (Taipei) 1994;53:248‑52. Yabek SM, Burstein J, Berman W Jr, Dillon T. Aberrant systemic arterial supply to the left lung with congestive heart failure. Chest 1981;80:636‑7. Tao CW, Chen CH, Yuen KH, Huang MH, Li WY, Perng RP. Anomalous systemic arterial supply to normal basilar segments of the lower lobe of the left lung. Chest 1992;102:1583‑5.
How to cite this article: Peringattuthodiyil Y, Christopher DJ, Balamugesh T, Saheer S. Aberrant arterial supply to left lung. Lung India 2015;32:287-8. Source of Support: Nil, Conflict of Interest: None declared.
Lung India • Vol 32 • Issue 3 • May - Jun 2015
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Aberrant arterial supply to left lung Yasir Peringattuthodiyil, Devasahayam Jesudas Christopher, T Balamugesh, S Saheer Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
Address for correspondence: Dr. Yasir Peringattuthodiyil, Department of Pulmonary Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. E‑mail: [email protected]
Anomalous systemic arterial supply to normal segments of the lung is a rare congenital anomaly. Although the etiology of systemic arterial supply to normal lung is still unknown, it is generally believed that this might result from an abnormal persistence of the embryonic connection between aorta and pulmonary parenchyma.[1] This disease was previously classified as Pryce Type I sequestration.[2] However, the absence of parenchymal abnormalities with a normal bronchial supply distinguishes systemic arterial supply from true pulmonary sequestration.[3] Review of published literature search shows that the systemic arterial supply is not usually associated with other anomalies.[4] Symptoms of systemic arterialization of the left lower lobe without sequestration were variable. Most patients were asymptomatic. Hemoptysis seemed to be an unusual manifestation.[5] Computed tomography often detects the lesion [Figure 1] but gold standard of diagnosis is selective angiogram. Pathological examination of anomalous arteries documented that the walls had elastic laminae within their media, but not the muscular layer, unlike bronchial arteries. Such a wall may not withstand the high pressure of the systemic circulation. [6] This might explain the mechanism of hemoptysis in the anomalous systemic arterial supply to the normal lung.
recommended because of its propensity for recurrent infection.[4] However, in pulmonary sequestration, if the parenchyma is normal, as one might encounter in systemic arterialization to lung, only a ligation of the systemic vessel by surgical ligation or coil embolization [Figure 2] may be sufficient.[5]
Figure 1: Contrast CT thorax showing a single branch from the descending thoracic aorta supplying basal segments of the left lower lobe
Treatment is recommended for all patients diagnosed with this anomaly ‑ with or without symptoms, because of its potential risk for hemoptysis.[7] Treatment options utilized in case reports include: Simple ligation of aberrant systemic artery, anastomosis to the pulmonary artery or simple lobectomy.[8] In pulmonary sequestration, resection of the sequestrated lung parenchyma is Access this article online Quick Response Code:
Website: www.lungindia.com DOI: 10.4103/0970-2113.156257
Figure 2: Check angiogram performed post deployment showing non-opacification of the distal aberrant artery with Amplatzer II plug in place
Lung India • Vol 32 • Issue 3 • May - Jun 2015 287
Peringattuthodiyil, et al.: Aberrant arterial supply to left lung
REFERENCES 1. 2. 3. 4. 5.
288
Kirks DR, Kane PE, Free EA, Taybi H. Systemic arterial supply to normal basilar segments of the left lower lobe. AJR Am J Roentgenol 1976;126:817‑21. Pryce DM. Lower accessory pulmonary artery with intralobar sequestration of lung; a report of seven cases. J Pathol Bacteriol 1946;58:457‑67. Oermann CM. Bronchopulmonary sequestration. Available from: http:// www.uptodate.com. [Last accessed on 2014 Jan 12] 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. Brühlmann W, Weishaupt D, Goebel N, Imhof E. Therapeutic embolization of a systemic arterialization of lung without sequestration. Eur Radiol 1998;8:355‑8.
6.
7. 8.
Cheng WE, Chen CH, Tao CW, Chern MS, Yuen KH, Perng RP. Anomalous systemic arterial supply to normal basilar segments of the left lower lobe of the lung: A case report. Zhonghua Yi Xue Za Zhi (Taipei) 1994;53:248‑52. Yabek SM, Burstein J, Berman W Jr, Dillon T. Aberrant systemic arterial supply to the left lung with congestive heart failure. Chest 1981;80:636‑7. Tao CW, Chen CH, Yuen KH, Huang MH, Li WY, Perng RP. Anomalous systemic arterial supply to normal basilar segments of the lower lobe of the left lung. Chest 1992;102:1583‑5.
How to cite this article: Peringattuthodiyil Y, Christopher DJ, Balamugesh T, Saheer S. Aberrant arterial supply to left lung. Lung India 2015;32:287-8. Source of Support: Nil, Conflict of Interest: None declared.
Lung India • Vol 32 • Issue 3 • May - Jun 2015
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
