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Anomalous systemic artery to right lower lobe basal segments

Published:September 22, 2022DOI:https://doi.org/10.1016/j.amjms.2022.09.011

      Case presentation

      A 33-year-old woman presented with a 2-year history of occasional hemoptysis. Routine laboratory test results were within the normal range, and clinical examination findings were unremarkable. Computed tomography angiography revealed an aberrant large systemic artery with wall calcification. This artery supplied blood to the basal segments of the right lower lobe (Fig. 1A, arrow). This anomalous artery originated from the celiac axis and entered the thorax via the esophageal hiatus, ran parallel to the esophagus on its right and eventually entered the right lower lobe via the pulmonary ligament, to supply the lateral, posterior, and medial basal segments. We observed only the right lower anterior basal segment pulmonary artery (Fig.1B thin arrow) and thickening of the inferior pulmonary basal segment vein (Fig. 1B thick arrow). The lung parenchyma showed ground-glass opacity with normal branching of the bronchial tree in the basal segments (Fig. 1C black arrow). The patient did not undergo surgery and is currently being followed up.
      Anomalous systemic arterial supply to the normal basal segments of the lower lobe is a rare congenital anomaly. There are two types of anomalous systemic artery to the lung, solitary systemic arterial supply and systemic arterial supply associated with normal pulmonary artery (double supply).
      • Qin J
      • Huang SH
      • Yan RH
      • et al.
      CT findings of anomalous systemic artery to the left lower lobe: comparison with pulmonary sequestration in the left lower lobe.
      The type of solitary systemic arterial supply is more common than dual arterial supply and more commonly described in the basal segments of the left lower lobe.
      • Irodi A
      • Cherian R
      • Keshava SN
      • et al.
      Dual arterial supply to normal lung: within the sequestration spectrum.
      In daily clinical practice, anomalous systemic artery to the lung is often confused with pulmonary sequestration. The CT findings of an anomalous systemic artery to the lung are characterized by a larger anomalous systemic artery arising from the thoracic or abdominal aorta, dilated inferior pulmonary veins, absence of the interlobar artery distal to the origin of the superior segmental artery, normal bronchial distribution, and ground glass opacity detected in the CT scan in the lower lobe. In contrast, pulmonary sequestration is typically mass-like with a round or pyramidal shape, supplied by a smaller anomalous artery, frequently containing cystic spaces, which may exhibit air-fluid levels. The recognition of these CT findings may be helpful in the differentiation of the two conditions.
      • Qin J
      • Huang SH
      • Yan RH
      • et al.
      CT findings of anomalous systemic artery to the left lower lobe: comparison with pulmonary sequestration in the left lower lobe.
      Most patients have no respiratory symptoms and can be treated conservatively. If there are clinical symptoms such as hemoptysis and congestive heart failure, surgical treatment is recommended. Operational procedures include lobectomy, segmentectomy, anastomosis between the anomalous artery and pulmonary artery, and ligation of the anomalous artery. Lobectomy is performed in most of the cases.
      • Gümüştaş S
      • Akça A
      • Ciftçi E
      • et al.
      A minimal invasive surgical alternative to aberrant systemic arterial supply: Coil embolization.

      Declaration of Competing Interest

      None.

      Source of Funding

      None.

      References

        • Qin J
        • Huang SH
        • Yan RH
        • et al.
        CT findings of anomalous systemic artery to the left lower lobe: comparison with pulmonary sequestration in the left lower lobe.
        Clin. Radiol. 2014; 69: e485-e490
        • Irodi A
        • Cherian R
        • Keshava SN
        • et al.
        Dual arterial supply to normal lung: within the sequestration spectrum.
        Br. J. Radiol. 2010; 83: e86-e89
        • Gümüştaş S
        • Akça A
        • Ciftçi E
        • et al.
        A minimal invasive surgical alternative to aberrant systemic arterial supply: Coil embolization.
        Interv. Med. Appl. Sci. 2013; 5: 34-38