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About 20&#37; of cases are irrigated by more than one artery&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">IS presents frequently in adolescents and young adults&#44; but rarely in adults over 40 years&#44; with recurrent infection and hemoptysis&#59; 15&#37; of patients are asymptomatic&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnosis is suggested by the identification of the abnormal blood vasculature in imaging studies&#46; The average rate of reported preoperative misdiagnosis in the literature is high&#46; Angiography used to be considered the method of choice for preoperative diagnosis&#44; has been replaced by non-invasive methods&#46; Conventional CT does not consistently show anomalous arterial supply&#46; Thus&#44; CT with contrast has emerged as the imaging test of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical resection is the treatment of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case report</span>&#58; Female patient&#44; Caucasian&#44; 64 years old&#44; house cleaner&#44; no smoking or alcohol habits&#46; Referred for pulmonology evaluation because she had asthenia and adynamia with one-year evolution&#44; weight loss &#40;13<span class="elsevierStyleHsp" style=""></span>kg in six months&#41;&#44; a CT showing fibrosis areas&#44; traction bronchiectasis and an encysted and loculated left pleural effusion&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In relation to antecedents&#44; the key was anaemia of unknown cause and an episode of respiratory infection which dragged on &#40;one year ago&#41;&#46; She did not report any hemoptysis episodes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A thoracic CT with contrast was performed and showed a vascular image in the internal basal segment of the left lower lobe&#44; 47<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>47<span class="elsevierStyleHsp" style=""></span>mm&#44; with at least two arteries originating from the lower thoracic aorta&#59; this was suggestive of PS&#46; There were also fibrosis areas and bronchiectasis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A left lower lobectomy was performed and the anomalous arteries were joined up&#46; An anatomopathological examination showed a cavitary formation of 5<span class="elsevierStyleHsp" style=""></span>cm&#44; with apparent communication with the bronchial tree and pulmonary condensation of the surrounding parenchyma&#46; Microscopically&#44; this was a cystic lesion lined with respiratory epithelium&#59; adjacent to this&#44; there were many dilated and mucous retention airspaces&#44; tortuous blood vessels and wall thickening&#44; which are consistent with IS&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A diagnostic hypothesis suggested from the first CT &#40;without contrast&#41; was encysted pleural effusion&#46; The performance of CT with contrast was central to the correct diagnosis of preoperative PS&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this case&#44; the highlights are the unusual age of onset of clinical presentation&#44; nonspecific and uncharacteristic symptomatology&#44; PS irrigated by two arteries and communication with the tracheobronchial tree&#46;</p></span>"
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Letter to the Editor
Diagnosis of pulmonary sequestration using imaging methods
Diagnóstico de sequestro pulmonar usando métodos de imagiologia
Rita Gomesa,c,
Corresponding author
, Filomena Luísb,c, Madalena Reisa
a Pulmonology Resident, Pulmonology Department at Sousa Martins Hospital, Local Health Unit, Guarda, Portugal
b Pulmonology Assistant, Pulmonology Department at Sousa Martins Hospital, Local Health Unit, Guarda, Portugal
c Faculty of Health Sciences of the University of Beira Interior, Portugal
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About 20&#37; of cases are irrigated by more than one artery&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">IS presents frequently in adolescents and young adults&#44; but rarely in adults over 40 years&#44; with recurrent infection and hemoptysis&#59; 15&#37; of patients are asymptomatic&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnosis is suggested by the identification of the abnormal blood vasculature in imaging studies&#46; The average rate of reported preoperative misdiagnosis in the literature is high&#46; Angiography used to be considered the method of choice for preoperative diagnosis&#44; has been replaced by non-invasive methods&#46; Conventional CT does not consistently show anomalous arterial supply&#46; Thus&#44; CT with contrast has emerged as the imaging test of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical resection is the treatment of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case report</span>&#58; Female patient&#44; Caucasian&#44; 64 years old&#44; house cleaner&#44; no smoking or alcohol habits&#46; Referred for pulmonology evaluation because she had asthenia and adynamia with one-year evolution&#44; weight loss &#40;13<span class="elsevierStyleHsp" style=""></span>kg in six months&#41;&#44; a CT showing fibrosis areas&#44; traction bronchiectasis and an encysted and loculated left pleural effusion&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In relation to antecedents&#44; the key was anaemia of unknown cause and an episode of respiratory infection which dragged on &#40;one year ago&#41;&#46; She did not report any hemoptysis episodes&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A thoracic CT with contrast was performed and showed a vascular image in the internal basal segment of the left lower lobe&#44; 47<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>47<span class="elsevierStyleHsp" style=""></span>mm&#44; with at least two arteries originating from the lower thoracic aorta&#59; this was suggestive of PS&#46; There were also fibrosis areas and bronchiectasis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A left lower lobectomy was performed and the anomalous arteries were joined up&#46; An anatomopathological examination showed a cavitary formation of 5<span class="elsevierStyleHsp" style=""></span>cm&#44; with apparent communication with the bronchial tree and pulmonary condensation of the surrounding parenchyma&#46; Microscopically&#44; this was a cystic lesion lined with respiratory epithelium&#59; adjacent to this&#44; there were many dilated and mucous retention airspaces&#44; tortuous blood vessels and wall thickening&#44; which are consistent with IS&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A diagnostic hypothesis suggested from the first CT &#40;without contrast&#41; was encysted pleural effusion&#46; The performance of CT with contrast was central to the correct diagnosis of preoperative PS&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this case&#44; the highlights are the unusual age of onset of clinical presentation&#44; nonspecific and uncharacteristic symptomatology&#44; PS irrigated by two arteries and communication with the tracheobronchial tree&#46;</p></span>"
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Article information
ISSN: 21735115
Original language: English
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