2. Case description
⢠Male patient 59 years old.Male patient 59 years old.
⢠Current smoker.Current smoker.
⢠Presented with recurrent attacks of bloodPresented with recurrent attacks of blood
tinged sputum (average 3 attacks/ year).tinged sputum (average 3 attacks/ year).
⢠First attack started 12 years ago.First attack started 12 years ago.
3. Case description
⢠The patient was first investigated in the
primary health care facility where chest X-
ray was done.
⢠He was diagnosed as a case of bronchitis
despite the obvious right paracardiac
opacity.
5. Case description
⢠The patient was treated with non specific
treatment.
⢠patient was admitted to a general hospital due to
another attack of hemoptysis with syncope.
⢠Thorax CT scan:
o Right lower lobe opacity with calcification.
6. CT of the chest
Right lower lobe opacity with calcification
7. Case description
⢠Due to the suspicious of malignancy:
ultrasonographic-guided aspiration was done twice.
⢠Pathological examination:
o Fibrous tissue with dilated vascular spaces.
8. Case description
⢠The patient was referred to the chest department
at the Mansoura university hospital for further
evaluation and bronchoscopy.
⢠After revision of the history and chest radiology,
pulmonary sequestration was suspected besides
other benign lung lesions.
9. Case description
⢠CT angiography:
o Right intralobular pulmonary sequestration.
o Dual arterial supply from right pulmonary artery
and multiple branches from abdominal aorta.
o The venous drainage into right pulmonary vein.
12. Pulmonary sequestration (PS)
⢠Congenital lung malformation:
o A mass of abnormal, nonfunctioning pulmonary tissue
o No communication with tracheobronchial tree
o Receive blood supply from an anomalous systemic artery
(instead of pulmonary arterial system)
o Usually occur in the left lower lobe
13. Types of PS
Intralobar PS
75%
Within visceral pleura of a
pulmonary lobe
Diagnosis is usually done at the
second decade of life.
Recurrent infection is common.
Not associated with other
anomalies
Extralobar PS
25%
Accessory lobe : tissue has its own
pleura
Diagnosis is usually made in
neonates or infants.
Often asymptomatic
Often associated with other
anomalies:
⢠Diaphragmatic hernia
â˘Cardiac malformation
â˘Foregut anomalies
14. Types of PS
Intralobar PS
PS has visceral pleura of a lung lobe
Extralobar PS
PS has its own pleura
15. Types of PS
Intralobar PS
Cystic changes and infection are
common
Extralobar PS
Infection is less common
22. Management
⢠Asymptomatic patient:
o Surgery is recommended.
⢠Prevent recurrent infections and the unfavorable
cardiac influence caused by the existing
aortopulmonary shunt.
25. ⢠The interesting points in our
case
o The late presentation of the
patient (59 years old)
o Unusual right-sided ILS
o The double blood supply
from both pulmonary artery
and abdominal aorta.
Conclusion