Signs and Symptoms of Chest Diseases |

A 55-Year-Old Woman With Cough and a Lung Nodule on Chest Radiograph FREE TO VIEW

Agustina Saenz*, MD; Ganesan Murali, MD; Kenneth Cavorsi, MD
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Albert Einstein Medical Center, Philadelphia, PA

Chest. 2012;142(4_MeetingAbstracts):1013A. doi:10.1378/chest.1382388
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SESSION TYPE: Miscellaneous Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: A 55 year-old female had presented with non-productive cough and shortness of breath to the pulmonary clinic. Her past medical history included hepatitis C, previous episodes of bronchitis and pneumonia 8 years ago.

CASE PRESENTATION: Diagnostic Tests and Radiographic Findings Baseline spirometry was normal. The chest radiograph revealed a faint focal nodular density in the left lower lobe (Fig 1). This was confirmed by a CT scan of the chest that revealed a 2.6 x 2.1 x 1.9 cm mass in the posterior basal segment of the left lower lobe surrounded by an area of air trapping. A feeding arterial supply from an intercostal artery and venous drainage into the left inferior pulmonary vein was also visualized. (Fig 2)

DISCUSSION: Lung sequestration was described by Pryce in 1946 1. Bronchopulmonary sequestration is a rare (0.15 to 6.4%)2 congenital lung malformation of the primitive foregut. Lung sequestrations can either be intralobar (ILS), with normal visceral pleura or extralobar (ELS) with its own pleura. Intralobar sequestrations represent 75%2 of lung sequestrations. ILS is usually acquired after bouts of severe pneumonia resulting in obliterative bronchitis, interruption of pulmonary arterial supply and development of alternate vascular supply from systemic circulation. In most cases, ILS receives its blood supply from the descending thoracic aorta and its drainage into the pulmonary venous system. Most often, the sequestered segment does not communicate with the normal bronchial tree. Both forms are usually located in the posterobasal segment of the left lower lobe. It may presents radiographically as a radio-opaque mass or diffuse parenchymal density, but definitive diagnosis is made by demonstration of systemic arterial supply to the sequestered lung segment.Differential diagnosis must include congential cystic adenomatoid malformation, congenital lobar emphysema, bronchogenic cyst, pulmonary arteriovenous malformation and neoplasm. Historically, treatment is performed in symptomatic patients by resection of the segment or lobe where the sequestration is located. Surgical resection is usually recommended.

CONCLUSIONS: . Our patient had presented with a chest radiograph and CT scan suspicious for neoplasm, but careful evaluation of her CT scan confirmed the feeding arterial supply from an intercostal artery and venous drainage into the left inferior pulmonary vein. Based on her paucity of significant symptoms; she is being followed up periodically.

1) Pryce DM. Lower accessory pulmonary artery with intralobar sequestration of lung: a report of seven cases. J Pathol. 1946; 58:457-67

2) Shibli M, Connery C, Shapiro J, Intralobar and extralobar bronchopulmonary sequestration complicated by Nocardia Asteroides infection, Southern Medical Association,2003, 0038/03/9601-0078

3) Donovan C, Edelman R, Vrachliotis T, Frank H, Kim D, Bronchopulmonary sequestration with MR angiographic evaluation, J of Vasc Diseases, 1994,45;239-244

DISCLOSURE: The following authors have nothing to disclose: Agustina Saenz, Ganesan Murali, Kenneth Cavorsi

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Albert Einstein Medical Center, Philadelphia, PA




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