M. Paetzel (Cleveland/USA)  

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11 Months  

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11 month-old child. In the course of a feverish infection, an x-ray was obtained. This showed a segmental opacity in the lower right lobe. After a 10 day antiobiotic treatment, the x-ray was unaffected. Clinical presentations of an infection were no longer to be seen. No increase of the CRP.  

Deformity: bronchopulmonary tissue has no connection to the bronchial system. The vasculature is always atypical via an artery of the systemic circulation.

Intralobular form: artery of the aorta, venous return into a lung vein (left-to-left shunt).
Air can penetrate through a Kohn pore.

Extralobular form: additional lung segment with its own pleura. The venous return occurs via an extrapulmonary vein (in this case: azygos vein, left-to-right shunt). Characteristically, this is located to the left, basally.  

<- view X-Ray 1

X-Ray 1: a.p.: Triangular (segmental) opacity in the lower field. This sits directly on the diaphragm.


<- view X-Ray 2

X-Ray 2: Lateral: Triangular (segmental) opacity in the lower field. This sits directly on the diaphragm.


<- view MRI

MRI 1: MR-Angiography (Contrast, T1-weighted GE-Sequence): Triangular signal intensive lesion just above the diapragm (green arrow) is shown. Atypical vessel supply of the abdominal aorta is shown (red arrow). The venous supply is through the azygos vein.

Imaging including endoscopy  

After the proof of abnormal veins: none. Without the proper MRI diagnostics, the probable differentials would be:

Pneumonia, Atelektasis, thracic placed spleen or kidney, tumor of unknown origin  

The child is furthermore without clinical symptoms.

In general, a surgery is recommenden, since the sequester could become inflamed. A left-right shunt could also be considered, but in this case, it would not have been sufficient.

If pulmonary sequesters can be treated by embolisation of the particular artery is still under scrutiny. If a reader has experience with this treatment, I would be highly interested in information regarding it.  

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Thorax-Lung  

congenital