Pulmonary sequestration is an unusual malformation consisting of isolated nonfunctioning lung segments lacking communication with functional tracheobronchial trees. Systemic blood supply is commonly from the thoracic aorta, but arteries occasionally arise from other sites. We report a rare form of pulmonary sequestration with arterial supply from the right coronary artery.
Aged ; Bronchopulmonary Sequestration/*pathology/radiography ; Coronary Angiography ; Coronary Vessel Anomalies/*pathology/radiography ; Female ; Humans

We presented a rare case of a 64-year-old man with a combined anomaly of the bronchus and pulmonary artery that was detected incidentally. Computed tomography showed a hyperlucent, aerated sequestered segment of the right lower lung with an independent ectopic bronchus, which had no connection to the other airway. The affected segment was supplied by its own aberrant pulmonary artery branch from the right pulmonary trunk. This anomaly cannot be classified with any of the previously reported anomalies.
Bronchi/pathology ; Bronchopulmonary Sequestration/*radiography ; Humans ; Lung/*radiography ; Male ; Middle Aged ; Pulmonary Artery/*radiography ; Tomography, X-Ray Computed

Routine chest radiography in a 21-year-old man revealed the presence of an asymptomatic mass at the right lower lung field. Chest radiographs showed multiple cysts with air-fluid level and air-meniscus within the consolidation at the right lower lung field. Chest CT scans demonstrated a non-enhancing solid mass, with air-meniscus, within a thin walled cavity, and multiple cysts with fluid or air-fluid level at the posterior portion of the right lower lobe. An abnormal artery was seen at the level of the 12th thoracic vertebra. Thoracic aortography revealed a feeding artery arising from the descending thoracic aorta and supplying the parenchymal lesion. We report the typical radiologic findings of intralobar pulmonary sequestration with aspergilloma, a condition confirmed by surgery and the pathologic findings.
Aorta, Thoracic ; Aortography ; Arteries ; Bronchopulmonary Sequestration* ; Humans ; Lung ; Radiography ; Radiography, Thoracic ; Spine ; Thorax ; Tomography, X-Ray Computed ; Young Adult

A 21-year-old woman presented with productive cough and hemoptysis. Chest radiograph shows a large thin-walled cystic lesion with an air-fluid level in medial portion of the left lower lung zone and opacity in paravertebral area of the right lower lung zone. Chest CT scan shows a thin-walled cavitary lesion in the posterior basal segment of left lower lobe with an air-fluid level. Area of consolidation containing air-filled cysts was also observed in medial aspect of right lower lobe. Selective angiogram obtained from aberrant artery arising from descending abdominal aorta showed two main branches of the artery supplying bilateral pulmonary lesions.
Aorta, Abdominal ; Arteries ; Bronchopulmonary Sequestration* ; Cough ; Female ; Hemoptysis ; Humans ; Lung ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Young Adult

Bronchopulmonary Sequestration ; classification ; pathology ; surgery ; Humans ; Infant ; Lung ; diagnostic imaging ; Male ; Radiography ; Respiratory System Abnormalities ; diagnosis ; surgery

OBJECTIVETo evaluate the clinical features, diagnosis, treatment, and outcome of intralobar pulmonary sequestration (ILS).

METHODSPatients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms, imaging findings, operative technique, complications, and outcome of these patients.

RESULTSForty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and angiography were performed. Thoracotomy was performed in 45 patients, while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively, 1 patient had atrial fibrillation, 1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically, 4 accompanied with bronchogenic cyst, 15 with bronchiectasis, 8 with infection, 2 with aspergilloma, and 1 with carcinoid. No late complications occurred.

CONCLUSIONSILS is rare, surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.

Adolescent ; Adult ; Bronchopulmonary Sequestration ; diagnosis ; diagnostic imaging ; surgery ; Child ; Congenital Abnormalities ; diagnosis ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVES: The evaluation and management of a patient with solitary pulmonary nodule(SPN) are guided by principles that were derived from earlier surgical studies. SPN has a relatively good prognosis even if it is a malignant lesion. In Korea, where there is a high incidence of pulmonary tuberculosis, approximately 40% to 70% of clinically encountered solitary pulmonary nodules are tuberculous lesions. SPNs can be diagnosed by clinical findings and chest imaging techniques, but confirmed only by pathologic or cytologic studies. Transthoracic needle aspiration biopsy(TNAB) or cytology will be diagnostic in 80% to 95% of malignant nodules, but will identify the benign nature in 50% to 90% of benign nodules; such results imply lower accuracy of TNBA or cytology in diagnosing benign nodules. Differential diagnosis of SPNs can be difficult in tuberculosis endemic areas, such as in Korea, Nested polymerase chain reaction(PCB) is the widely used method to test very small amount of pathogene and to detect M, tuberculosis in fine needle aspirates. METHODS: 33 patients with SPN found on chest radiographs were evaluated by chest CT, mycobacteriologic and cytologic studies from sputum, bronchial washing fluids, and transthoracic fine needle aspirates, 17 cases were malignant SPNs(51.5%), consisting af 14 primary lung cancers and 3 metastatic SPNs, 18 cases were benign SPNs(48.5%), consisting of 8 tuberculous, 4 localized pneumonia, 1 pulmonary sequestration, and 3 radiologically suspected tuberculous lesions without response to anti-TB drugs. Nested PCR for detecting M. tuberculosis using TB-1, TB-2, TB-28, and TB-29C was carried out on fine needle aspirates from 33 patients with SPN. RESULTS: Among the pathologically proven 17 malignant SFNs, 15(88.5%) cases were detected as cancer on chest CT. 15(88.5%) cases were confirmed by transthoracic needle aspiration cytology, among which 3(17.7%) cases showed positive on sputum cytology, and other 3(17.7%) cases yielded positive on bronchial washing cytology as well. Two cases of malignant nodules were confirmed by open resection. In 8 tuberculous SPNs, Neither AFB stain of sputum, bronchial washings, nor transthoracic needle aspirates showed positive. However, mycobacterium was cultured in 1 (9.l%) case from sputum, in 3 (27.3%) cases from bronchial washing fluids, and in 2 (18.2%) cases from transthoracic needle aspirates. Thus, five cases were confirmed bacteriologically; one case had positive culture results on both bronchial washing and transthoracic needle aspirates. Three out of 8 tuberculous cases were radiologically suspected and showed response to anti-TB drugs, but were not bacteriologically confirmed. Chest CT could detect 72.7% of tuberculous nodules. Aspirates from malignancy, pneumonia, and sequestration were negative on nested PCR for tuberculosis, One of the 3 radiologically suspected tuberculous nadules without response to anti-TB drugs yielded positive results on nested PCR for M, tuberculosis. In contrast, 7 out of 8(87.5%) aspirates from proven tuberculous nodules showed positive results on nested PCR for M. tuberculous, which included 4 bacteriologically proven tuberculous nodules and 3 radiologically suspected tuberculous nodules with response to anti-TB drugs. CONCLUSION: Nested PCR could be used to detect M. tuberculosis in fine needle aspirates from tuberculous SPN with good sensitivity (87.5%) and specificity(96.0%). Therefore, nested PCR for detecting M. tuberculosis in fine needle aspirates may be useful in the differential diagnosis of solitary pulmonary nodules.
Bronchopulmonary Sequestration ; Diagnosis, Differential* ; Humans ; Incidence ; Korea ; Lung Neoplasms ; Mycobacterium ; Needles ; Pneumonia ; Polymerase Chain Reaction ; Prognosis ; Radiography, Thoracic ; Solitary Pulmonary Nodule* ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary

PURPOSE: Congenital pulmonary airway malformation (CPAM)—a rare developmental anomaly—affects the lower respiratory tract in newborns. By comparing the reliability of diagnostic tools and identifying predictive factors for symptoms, we provide comprehensive clinical data for the proper management of CPAM. METHODS: We reviewed the medical records of 66 patients with prenatally diagnosed CPAM delivered at Severance Children's Hospital between January 2005 and July 2017. RESULTS: We enrolled 33 boys and 33 girls. Their mean gestational age and birth weight were 38.8 weeks and 3,050 g, respectively. Prenatal ultrasonography and postnatal radiography, lung ultrasonography, and chest computed tomography (CT) showed inconsistent findings. Chest CT showed superior sensitivity (100%) and positive predictive value (90%). Among the 66 patients, 59 had postnatally confirmed CPAM, three had pulmonary sequestration, one had cystic teratoma, and one had a normal lung. Of the 59 patients with CPAM, 21 (35%; mean age, 23.4 months) underwent surgery, including 15 who underwent video-assisted thoracoscopy. Twenty-five and 12 patients exhibited respiratory symptoms at birth and during infancy, respectively. Apgar scores and mediastinal shift on radiography were significantly associated with respiratory symptoms at birth. However, none of the factors could predict respiratory symptoms during infancy. CONCLUSION: Radiography or ultrasonography combined with chest CT can confirm an unclear or inconsistent lesion. Apgar scores and mediastinal shift on radiography can predict respiratory symptoms at birth. However, symptoms during infancy are not associated with prenatal and postnatal factors. Chest CT combined with periodic symptom monitoring is important for diagnosing and managing patients with prenatally diagnosed CPAM and to guide appropriate timing of surgery.
Birth Weight ; Bronchopulmonary Sequestration ; Cystic Adenomatoid Malformation of Lung, Congenital ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Lung ; Medical Records ; Parturition ; Radiography ; Respiratory System ; Teratoma ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography ; Ultrasonography, Prenatal