Correct!
2. Bronchopulmonary intralobar sequestration

All of the lesions listed could cause gas-containing abnormalities in the lung. Among the choices listed, however, only bronchopulmonary intralobar sequestration would be associated with aberrant arterial blood supply derived from the aorta. Cardiopulmonary surgical consultation recommended surgical resection of the lesion, given the evidence of recurrent infection. The patient was taken to the operating room after the aberrant vessel supplying the lesion was embolized (Figure 10).

Figure 10. Image of catheter aortography with selective cannulation of the aberrant artery following coil embolization of this vessel shows complete occlusion of the aberrant vessel with no residual flow to the cystic medial right lower lobe lesion.

This vessel was successfully identified in the pulmonary ligament, ligated, and the right lower lobe lesion was successfully resected (Figure 10), despite some difficulty owing to adhesions from the previous right thoracotomy.

Figure 11. Gross pathological specimen of the resected cystic right lower lobe lesion.

Diagnosis: Intralobar bronchopulmonary sequestration

References

  1. Polaczek M, Baranska I, Szolkowska M, Zych J, Rudzinski P, Szopinski J, Orlowski T, Roszkowski-Sliz K. Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration. J Thorac Dis. 2017;9(3):762-7. [CrossRef] [PubMed]
  2. Ren JZ, Zhang K, Huang GH, Zhang MF, Zhou PL, Han XW, Duan XH, Li Z. Assessment of 64-row computed tomographic angiography for diagnosis and pretreatment planning in pulmonary sequestration. Radiol Med. 2014;119(1):27-32. [CrossRef] [PubMed]
  3. Litt D, Gandhi S, Bhinder S, Blitz M, McIntyre K. Incidental finding and management of intralobar sequestration of the lung in a 24-year-old man. Can Respir J. 2013;20(6):403-5. [CrossRef] [PubMed]
  4. Saxena P, Marshall M, Ng L, Sinha A, Edwards M. Preoperative embolization of aberrant systemic artery in sequestration of lung. Asian Cardiovasc Thorac Ann. 2011;19(5):357-9. [CrossRef] [PubMed]
  5. Marine LM, Valdes FE, Mertens RM, Bergoeing MR, Kramer A. Endovascular treatment of symptomatic pulmonary sequestration. Ann Vasc Surg. 2011;25(5):696.e11-5. [CrossRef] [PubMed]
  6. Molinari F, Paolantonio G, Valente S, Pirronti T, Bonomo L. Images in cardiovascular medicine. Intralobar pulmonary sequestration in a 46-year-old woman: findings from multidetector-row computed tomography and magnetic resonance imaging. Circulation. 2009;119(11):e368-70. [CrossRef] [PubMed]
  7. 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(5):331-4. [PubMed]

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