Original Article
Comparison of anomalous systemic artery to left lower lobe and pulmonary sequestration in left lower lobe by computed tomography
Acta Radiologica 2015, Vol. 56(9) 1100–1104 ! The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0284185114545149 acr.sagepub.com
Jie Qin1,*, Xiao-li Wang2,*, Ming-jun Bai1, Shao-hong Huang3, Xiu-zhen Chen1 and Hong Shan1
Abstract Background: Differentiation of anomalous systemic artery to the left lower lobe (ASALLL) from pulmonary sequestration (PS) is essential, as ASALLL can be corrected by anastomosis, embolization, or ligation of the anomalous artery. Purpose: To compare computed tomography (CT) findings of ASALLL and PS in the left lower lobe (LLL). Materials and methods: This study included 16 patients with ASALLL and 25 patients with PS in LLL confirmed by operative and pathologic findings. Results: Cough and sputum were more common in PS (84% and 60%, respectively) than in ASALLL (25% and 12.5%, respectively) (P < 0.05). Hemoptysis was more common in ASALLL (100%) than in PS (24%) (P < 0.05). The frequency of ground glass opacity (GGO), normal bronchial distribution, dilated left inferior pulmonary veins, and absence of the interlobar artery distal to the origin of the superior segmental artery in LLL differed significantly between ASALLL and PS. Mass was less common in ASALLL (0%) than in PS (88%) (P < 0.01). The mean diameter of the anomalous artery (11.88 1.13 mm) in ASALLL was significantly larger than that (5.96 0.98 mm) in PS (P < 0.01). The presence of anomalous artery arising from thoracic aorta was not different between ASALLL (100%) and PS (72%). Conclusion: Radiographic indications of ASALLL differ from those of PS in the LLL. Indications that may suggest ASALLL include an enlarged anomalous systemic artery arising from the thoracic aorta, dilated left inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, normal bronchial distribution, and GGO in the LLL.
Keywords Anomalous systemic artery, sequestration, computed tomography (CT), X-ray Date received: 22 March 2014; accepted: 5 July 2014
Introduction Anomalous systemic artery to the left lower lobe (ASALLL), which has no normal pulmonary arterial supply (LLL), is a congenital anomaly that does not affect bronchial connections (1). ASALLL was previously classified as a type I pulmonary sequestration (PS) according to Pryce’s terminology (2). Whether the term ‘‘sequestration’’ is appropriate remains controversial because bronchial connections remain intact (3–5). PS, however, is an anomaly in which an anomalous systemic artery disrupts communication of the pulmonary tissue with the tracheobronchial tree (5). In most cases of ASALLL and PS, lobectomy or segmentectomy can be performed (1,3), while other
operative procedures such as anastomosis between the anomalous artery and the pulmonary artery, 1 Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China 2 Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China 3 Division of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
*Jie Qin and Xiao-li Wang contributed equally to this work. Corresponding author: Jie Qin, Department of Radiology, the Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, PR China. Email: [email protected]
Downloaded from acr.sagepub.com at Gazi University on December 31, 2015
Qin et al.
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embolization, or ligation of the anomalous artery, can be performed only in patients with ASALLL (1,3,6–8). Therefore, it is very important to differentiate ASALLL from PS. To our knowledge, little information is available on the CT features that may distinguish ASALLL from PS. In this study, we compared the CT findings of 16 patients with ASALLL and 25 patients with PS in LLL confirmed by operative and pathologic findings.
Material and Methods Patients This study included 41 patients admitted to our hospital for surgery, including 16 patients with ASALLL (11 men, 5 women; mean age 23 5 years) and 25 patients with PS (15 men, 10 women; mean age 27 7 years). Patients were selected from a population of 857 who underwent lobectomy or segmentectomy in our institution from January 2005 to August 2013 by a review of medical records. Of these 857 patients, lobectomy or segmentectomy of the left lower lobe was performed in 435, and of these those, 16 and 25 patients were diagnosed with either ASALLL or PS, respectively. All patients’ symptoms completely resolved after surgery. No mortality was encountered.
CT scanning Chest CT images were obtained with a 320-detector CT scanner (Aquilion ONE; Toshiba Medical Systems, Ottawara, Japan) (n ¼ 29) or a HiSpeed Advantage scanner (GE Healthcare, Milwaukee, WI, USA) (n ¼ 12). Scan parameters were as follows: 120 kV, 160–250 mAs. The reconstructed slice thickness and interslice interval were 3 mm. Routine chest CT images were obtained from the apex to the base of the lung and were viewed using standard lung (level, 700 HU; width, 1500 HU) and mediastinal windows (level, 40 HU; width, 400 HU). Iodinated non-ionic contrast medium (Iopromide; 300 mg/mL; Schering Pharmaceutical Ltd., Guangzhou, China) was administered at a rate of 2.5 mL/s with a mechanical injector. Multi-planar curve reconstructions (MCR), maximum intensity projections (MIP), and three-dimensional (3D) volume rendered images were generated.
Data analysis Chest CT images and clinical findings were analyzed by consensus by two experienced radiologists (JQ and MJB, who have 15 and 10 years of experience in chest imaging, respectively) individually. Chest pain, cough, sputum, fever, and hemoptysis were evaluated in all patients. CT images were assessed for the following patterns of abnormality: GGO or mass, bronchial distribution, dilated left inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, and the origin and mean diameter of the anomalous artery. The diameter of the anomalous artery was measured at its origin.
Statistical analysis All statistical analyses were performed using the Statistical Package for the Social Sciences software package version 20.0 (SPSS Inc., Chicago, IL, USA). Continuous data were expressed as the means with standard deviations (SD) and categorical data as numbers with related percentages (n, %). Differences in continuous data were analyzed using Student’s t-test, and categorical data were compared using the chi-square test. A two-tailed P value
Comparison of anomalous systemic artery to left lower lobe and pulmonary sequestration in left lower lobe by computed tomography
Acta Radiologica 2015, Vol. 56(9) 1100–1104 ! The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0284185114545149 acr.sagepub.com
Jie Qin1,*, Xiao-li Wang2,*, Ming-jun Bai1, Shao-hong Huang3, Xiu-zhen Chen1 and Hong Shan1
Abstract Background: Differentiation of anomalous systemic artery to the left lower lobe (ASALLL) from pulmonary sequestration (PS) is essential, as ASALLL can be corrected by anastomosis, embolization, or ligation of the anomalous artery. Purpose: To compare computed tomography (CT) findings of ASALLL and PS in the left lower lobe (LLL). Materials and methods: This study included 16 patients with ASALLL and 25 patients with PS in LLL confirmed by operative and pathologic findings. Results: Cough and sputum were more common in PS (84% and 60%, respectively) than in ASALLL (25% and 12.5%, respectively) (P < 0.05). Hemoptysis was more common in ASALLL (100%) than in PS (24%) (P < 0.05). The frequency of ground glass opacity (GGO), normal bronchial distribution, dilated left inferior pulmonary veins, and absence of the interlobar artery distal to the origin of the superior segmental artery in LLL differed significantly between ASALLL and PS. Mass was less common in ASALLL (0%) than in PS (88%) (P < 0.01). The mean diameter of the anomalous artery (11.88 1.13 mm) in ASALLL was significantly larger than that (5.96 0.98 mm) in PS (P < 0.01). The presence of anomalous artery arising from thoracic aorta was not different between ASALLL (100%) and PS (72%). Conclusion: Radiographic indications of ASALLL differ from those of PS in the LLL. Indications that may suggest ASALLL include an enlarged anomalous systemic artery arising from the thoracic aorta, dilated left inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, normal bronchial distribution, and GGO in the LLL.
Keywords Anomalous systemic artery, sequestration, computed tomography (CT), X-ray Date received: 22 March 2014; accepted: 5 July 2014
Introduction Anomalous systemic artery to the left lower lobe (ASALLL), which has no normal pulmonary arterial supply (LLL), is a congenital anomaly that does not affect bronchial connections (1). ASALLL was previously classified as a type I pulmonary sequestration (PS) according to Pryce’s terminology (2). Whether the term ‘‘sequestration’’ is appropriate remains controversial because bronchial connections remain intact (3–5). PS, however, is an anomaly in which an anomalous systemic artery disrupts communication of the pulmonary tissue with the tracheobronchial tree (5). In most cases of ASALLL and PS, lobectomy or segmentectomy can be performed (1,3), while other
operative procedures such as anastomosis between the anomalous artery and the pulmonary artery, 1 Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China 2 Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China 3 Division of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
*Jie Qin and Xiao-li Wang contributed equally to this work. Corresponding author: Jie Qin, Department of Radiology, the Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, PR China. Email: [email protected]
Downloaded from acr.sagepub.com at Gazi University on December 31, 2015
Qin et al.
1101
embolization, or ligation of the anomalous artery, can be performed only in patients with ASALLL (1,3,6–8). Therefore, it is very important to differentiate ASALLL from PS. To our knowledge, little information is available on the CT features that may distinguish ASALLL from PS. In this study, we compared the CT findings of 16 patients with ASALLL and 25 patients with PS in LLL confirmed by operative and pathologic findings.
Material and Methods Patients This study included 41 patients admitted to our hospital for surgery, including 16 patients with ASALLL (11 men, 5 women; mean age 23 5 years) and 25 patients with PS (15 men, 10 women; mean age 27 7 years). Patients were selected from a population of 857 who underwent lobectomy or segmentectomy in our institution from January 2005 to August 2013 by a review of medical records. Of these 857 patients, lobectomy or segmentectomy of the left lower lobe was performed in 435, and of these those, 16 and 25 patients were diagnosed with either ASALLL or PS, respectively. All patients’ symptoms completely resolved after surgery. No mortality was encountered.
CT scanning Chest CT images were obtained with a 320-detector CT scanner (Aquilion ONE; Toshiba Medical Systems, Ottawara, Japan) (n ¼ 29) or a HiSpeed Advantage scanner (GE Healthcare, Milwaukee, WI, USA) (n ¼ 12). Scan parameters were as follows: 120 kV, 160–250 mAs. The reconstructed slice thickness and interslice interval were 3 mm. Routine chest CT images were obtained from the apex to the base of the lung and were viewed using standard lung (level, 700 HU; width, 1500 HU) and mediastinal windows (level, 40 HU; width, 400 HU). Iodinated non-ionic contrast medium (Iopromide; 300 mg/mL; Schering Pharmaceutical Ltd., Guangzhou, China) was administered at a rate of 2.5 mL/s with a mechanical injector. Multi-planar curve reconstructions (MCR), maximum intensity projections (MIP), and three-dimensional (3D) volume rendered images were generated.
Data analysis Chest CT images and clinical findings were analyzed by consensus by two experienced radiologists (JQ and MJB, who have 15 and 10 years of experience in chest imaging, respectively) individually. Chest pain, cough, sputum, fever, and hemoptysis were evaluated in all patients. CT images were assessed for the following patterns of abnormality: GGO or mass, bronchial distribution, dilated left inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, and the origin and mean diameter of the anomalous artery. The diameter of the anomalous artery was measured at its origin.
Statistical analysis All statistical analyses were performed using the Statistical Package for the Social Sciences software package version 20.0 (SPSS Inc., Chicago, IL, USA). Continuous data were expressed as the means with standard deviations (SD) and categorical data as numbers with related percentages (n, %). Differences in continuous data were analyzed using Student’s t-test, and categorical data were compared using the chi-square test. A two-tailed P value
