Noninvasive Imaging of Bronchopulmonary Sequestration
Sheung-Fat Ko1,
Shu-Hang Ng1,
Tze-Yu Lee1,
Yung-Liang Wan1,
Chi-Di Liang2,
Jui-Wei Lin3,
Wei-Jen Chen3 and
Ming-Jeng Hsieh4
1
Department Radiology, Chang Gung Memorial Hospitals at Kaohsiung and Linkou,
Chang Gung University, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien 833,
Taiwan.
2
Department of Pediatrics, Chang Gung Memorial Hospital at Kaohsiung, Chang
Gung University, Kaohsiung Hsien 833, Taiwan.
3
Department of Pathology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung
University, Kaohsiung Hsien 833, Taiwan.
4
Department of Cardiovascular and Thoracic Surgery, Chang Gung Memorial
Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien 833,
Taiwan.
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Fig. 1A. —15-year-old girl with intralobar bronchopulmonary sequestration who
presented with chronic left lower chest discomfort. Frontal chest radiograph
shows large well-defined homogeneous opacity (arrowheads) in left
lower lung field.
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Fig. 1B. —15-year-old girl with intralobar bronchopulmonary sequestration who
presented with chronic left lower chest discomfort. Helical CT scan with 3-mm
reconstruction interval shows mass with cystic components
(arrowheads) in left lower lobe. Note aberrant systemic artery
(arrow) originating from descending thoracic aorta.
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Fig. 1C. —15-year-old girl with intralobar bronchopulmonary sequestration who
presented with chronic left lower chest discomfort. CT angiogram with
maximum-intensity-projection reconstruction shows aberrant systemic artery
extending from descending thoracic aorta.
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Fig. 1D. —15-year-old girl with intralobar bronchopulmonary sequestration who
presented with chronic left lower chest discomfort. Digital subtraction
angiogram confirms findings (arrowhead) seen on C. Note venous
drainage via left inferior pulmonary vein (arrows).
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Fig. 1E. —15-year-old girl with intralobar bronchopulmonary sequestration who
presented with chronic left lower chest discomfort. Gross specimen of excised
left lower lobe reveals large mass (arrowheads) with numerous cystic
spaces. Mass and normal lung parenchyma are enclosed within visceral
pleura.
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Fig. 1F. —15-year-old girl with intralobar bronchopulmonary sequestration who
presented with chronic left lower chest discomfort. Photomicrograph of
histopathologic section shows multiple cystic spaces with mucin content or
intracystic hemorrhage. Cystic spaces are lined with respiratory epithelium,
intervening connective tissue, and acute and chronic inflammatory cells. (H
and E, x250)
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Fig. 2A. —1-month-old female infant with extralobar bronchopulmonary
sequestration between left lower lobe and left hemidiaphragm, who presented
with marked hypoglycemia as result of nesidioblastosis of pancreas and ectopic
pancreatic tissues in duodenum and small intestine. Chest radiograph shows
mild flattening of left hemidiaphragm (arrowheads) and blunting of
left costophrenic angle.
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Fig. 2B. —1-month-old female infant with extralobar bronchopulmonary
sequestration between left lower lobe and left hemidiaphragm, who presented
with marked hypoglycemia as result of nesidioblastosis of pancreas and ectopic
pancreatic tissues in duodenum and small intestine. Sonogram for screening for
pancreatic or other abdominal abnormalities incidentally reveals echogenic
mass with multiple cystic components (arrows) above left
hemidiaphragm. No abnormal vessel is seen.
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Fig. 2C. —1-month-old female infant with extralobar bronchopulmonary
sequestration between left lower lobe and left hemidiaphragm, who presented
with marked hypoglycemia as result of nesidioblastosis of pancreas and ectopic
pancreatic tissues in duodenum and small intestine. Helical CT scan with 1-mm
reconstruction interval shows inhomogeneous mass in posterior part of left
lower chest with small aberrant systemic artery (arrows) from
thoracolumbar aorta. Cystic components are less apparent on CT than on
sonography.
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Fig. 2D. —1-month-old female infant with extralobar bronchopulmonary
sequestration between left lower lobe and left hemidiaphragm, who presented
with marked hypoglycemia as result of nesidioblastosis of pancreas and ectopic
pancreatic tissues in duodenum and small intestine. Cut section of gross
specimen shows pyramid-shaped mass with multiple cysts invested with its own
pleura.
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Fig. 3A. —Asymptomatic 46-year-old man with intralobar bronchopulmonary
sequestration. Chest radiograph incidentally reveals ovoid mass
(arrows) in posteromedial part of right lower lung field.
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Fig. 4A. —20-year-old woman with intralobar bronchopulmonary sequestration who
presented with chronic cough and acute right chest pain. Chest radiograph
shows cavitary lesion with air-fluid level in right middle lung field.
Pneumothorax (arrows) is also noted.
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Fig. 5A. —20-year-old woman with intralobar bronchopulmonary sequestration who
presented with recurrent fever and intractable cough with purulent sputum.
Chest radiograph shows lobar consolidation in left lower lung field.
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Fig. 6A. —Asymptomatic 29-year-old man with intralobar bronchopulmonary
sequestration. Chest radiograph shows irregular mass (arrowheads) in
left upper lung field.
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Fig. 7A. —1-year-old boy with intralobar bronchopulmonary sequestration who
presented with persistent cough. Chest radiograph shows focal hyperradiolucent
area (arrowheads) in right lower lung field.
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Fig. 8A. —18-year-old man with intralobar bronchopulmonary sequestration who
presented with cough. Left longitudinal color Doppler sonogram (in
black-and-white photograph) shows homogeneous echogenic mass with aberrant
vessel (arrow) originating from aorta (arrowheads).
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Fig. 8B. —18-year-old man with intralobar bronchopulmonary sequestration who
presented with cough. Spectral Doppler tracing reveals arterial waveform of
aberrant systemic artery.
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Fig. 3B. —Asymptomatic 46-year-old man with intralobar bronchopulmonary
sequestration. CT scan shows well-defined, thin-walled cystic lesion with mild
focal thickening in posterior wall (arrow). Note atelectatic change
of posterobasal segment of right lower lobe (arrowheads).
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Fig. 4B. —20-year-old woman with intralobar bronchopulmonary sequestration who
presented with chronic cough and acute right chest pain. CT scan shows
multiple air-containing thin-walled cysts in right upper lobe, with air-fluid
level in largest one. Note pneumothorax compressing right upper lobe
(arrows).
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Fig. 5B. —20-year-old woman with intralobar bronchopulmonary sequestration who
presented with recurrent fever and intractable cough with purulent sputum. CT
scan shows numerous small air-containing and fluid-filled cysts in left lower
lobe.
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Fig. 9A. —36-year-old man with intralobar bronchopulmonary sequestration who
presented with intermittent hemoptysis. CT scan shows focal atelectatic change
in medial part of right lower lobe (arrows) with emphysematous
changes at border (arrowheads).
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Fig. 9B. —36-year-old man with intralobar bronchopulmonary sequestration who
presented with intermittent hemoptysis. Photomicrograph of histopathologic
section shows emphysematous change (arrows) of peripheral part of
bronchopulmonary sequestration and adjacent lung parenchyma. (H and E,
x250)
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Fig. 7B. —1-year-old boy with intralobar bronchopulmonary sequestration who
presented with persistent cough. CT scan shows multiple thin-walled cysts with
air-trapping appearance (arrowheads) in right lower lobe.
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Fig. 6B. —Asymptomatic 29-year-old man with intralobar bronchopulmonary
sequestration. CT scan shows spiculated mass (arrow) in left upper
lobe.
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Fig. 10. —6-year-old girl with intralobar bronchopulmonary sequestration who
presented with recurrent fever and cough. CT scan shows inhomogeneous mass
(arrowheads) in left lower lobe and engorged azygos vein
(arrow).
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Fig. 11. —4-month-old male infant with intralobar bronchopulmonary
sequestration who presented with nonproductive cough that had persisted since
birth. Coronal T1-weighted MR image shows hyperintense mass in left lower lobe
with large aberrant systemic artery (arrows) arising from descending
thoracic aorta with venous drainage (arrowheads) via hemiazygos and
azygos veins.
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Fig. 12A. —16-year-old girl with intralobar bronchopulmonary sequestration who
presented with cough and recurrent episodes of high fever. Reconstructed
oblique coronal T1-weighted MR image shows hyperintense mass with irregular
upper border in left lower lobe. Aberrant systemic artery
(arrowheads) originates from descending thoracic aorta, with venous
drainage via left inferior pulmonary vein (arrows).
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Fig. 13A. —46-year-old woman with intralobar bronchopulmonary sequestration who
presented with recurrent hemoptysis. Soft-tissue density mass in medial part
of left lung base was noted on CT (not shown). Time-of-flight MR angiogram in
coronal projection shows abnormal vessel (arrowheads) from abdominal
aorta tracking to mass in left lung base. Indistinct tubular shadow
(arrows) in retrocardiac region is also shown.
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Fig. 13B. —46-year-old woman with intralobar bronchopulmonary sequestration who
presented with recurrent hemoptysis. Soft-tissue density mass in medial part
of left lung base was noted on CT (not shown). Digital subtraction angiogram
confirms time-of-flight MR angiographic findings by revealing left lung base
mass (thick arrow) supplied by aberrant systemic artery
(arrowheads) and venous drainage via engorged left inferior pulmonary
vein (thin arrows).
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Fig. 12B. —16-year-old girl with intralobar bronchopulmonary sequestration who
presented with cough and recurrent episodes of high fever. Gadolinium-enhanced
three-dimensional MR angiogram in coronal oblique projection allows clear
display of aberrant systemic artery (arrowheads) arising from
descending aorta and mildly dilated left inferior pulmonary vein
(arrows).
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