Answer for BIR CoW 22 Nov 2020
Anomalous systemic arterial supply to normal lung
Findings
Both lower lung fields are clear , CT Angiography show prominent artery seen arising from the celiac axis with specks of calcification supplying the right lower lobe. Note the presence of normal pulmonary artery branches accompanying the right lower lobe bronchi indicating dual arterial supply. Coronal chest section depicts systemic arterial supply to left lower lobe.
Discussion
Anomalous systemic arterial supply to normal lung Anomalous systemic arterial supply to normal lung is an anatomical variant in which a portion of the lung (usually a basal segment) is supplied by a systemic vessel without a distinct pulmonary sequestration.It was traditionally (perhaps inappropriately since not a true sequestration) called a Pryce type 1 sequestration Subtypes It can be of two subtypes: A.) isolated systemic arterial supply to normal lung (ISSNL) B.) systemic arterial supply associated with normal pulmonary artery (dual supply) Dual arterial supply to normal lung This is a rare congenital entity in which a lobar segment of lung, typically lower lobes, receives dual arterial supply from both systemic artery (arising from aorta or branches) and pulmonary artery. Patients can be asymptomatic or present with hemoptysis Isolated systemic supply to normal lung In isolated systemic supply to normal lung (ISSNL), there is aberrant supply to a lobar segment of lung (right/left lower lobe) by a systemic artery in the absence of normal pulmonary arterial supply. This entity is also known as pseudosequestration as the lung shows normal communication with tracheobronchial tree. When the right lower lobe is involved, it is usually supplied by an artery arising from celiac trunk or abdominal aorta. Patients with ISSNL can be asymptomatic or present with hemoptysis and exertional dyspnea due to left side volume overload. Surgery or coiling of aberrant systemic artery may be required in patients with hemoptysis.
Reference
1. Singh AS, Subbain SK, Subramanian KG, Agarwal R, Dave DJ, Kulkarni S, et al. Pseudosequestration of the Left Lung. Tex Heart Inst J 2007;34:195-8.
2.Clements BS, Warner JO. Pulmonary sequestration and related congenital bronchopulmonary-vascular malformations: Nomenclature and classification based on anatomical and embryological considerations. Thorax 1987;42:401-8. Back to cited text no. 4
Findings
Both lower lung fields are clear , CT Angiography show prominent artery seen arising from the celiac axis with specks of calcification supplying the right lower lobe. Note the presence of normal pulmonary artery branches accompanying the right lower lobe bronchi indicating dual arterial supply. Coronal chest section depicts systemic arterial supply to left lower lobe.
Discussion
Anomalous systemic arterial supply to normal lung Anomalous systemic arterial supply to normal lung is an anatomical variant in which a portion of the lung (usually a basal segment) is supplied by a systemic vessel without a distinct pulmonary sequestration.It was traditionally (perhaps inappropriately since not a true sequestration) called a Pryce type 1 sequestration Subtypes It can be of two subtypes: A.) isolated systemic arterial supply to normal lung (ISSNL) B.) systemic arterial supply associated with normal pulmonary artery (dual supply) Dual arterial supply to normal lung This is a rare congenital entity in which a lobar segment of lung, typically lower lobes, receives dual arterial supply from both systemic artery (arising from aorta or branches) and pulmonary artery. Patients can be asymptomatic or present with hemoptysis Isolated systemic supply to normal lung In isolated systemic supply to normal lung (ISSNL), there is aberrant supply to a lobar segment of lung (right/left lower lobe) by a systemic artery in the absence of normal pulmonary arterial supply. This entity is also known as pseudosequestration as the lung shows normal communication with tracheobronchial tree. When the right lower lobe is involved, it is usually supplied by an artery arising from celiac trunk or abdominal aorta. Patients with ISSNL can be asymptomatic or present with hemoptysis and exertional dyspnea due to left side volume overload. Surgery or coiling of aberrant systemic artery may be required in patients with hemoptysis.
Reference
1. Singh AS, Subbain SK, Subramanian KG, Agarwal R, Dave DJ, Kulkarni S, et al. Pseudosequestration of the Left Lung. Tex Heart Inst J 2007;34:195-8.
2.Clements BS, Warner JO. Pulmonary sequestration and related congenital bronchopulmonary-vascular malformations: Nomenclature and classification based on anatomical and embryological considerations. Thorax 1987;42:401-8. Back to cited text no. 4
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!