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Evaluation of Angioarchitecture of Pulmonary Sequestration in Pediatric Patients Using 3D MDCT Angiography

¹ Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110.
² Department of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Pl., St. Louis, MO 63110.

View larger version (103K): [in a new window]   Fig. 1A. —6-month-old girl who presented with recurrent left lower lobe pneumonia. At surgery, patient was found to have intralobar sequestration with anomalous arterial vessel arising from thoracic aorta and anomalous venous drainage into left atrium. Axial CT image shows anomalous arterial supply (arrow) to sequestered lung (S), arising from thoracic aorta (A).

View larger version (70K): [in a new window]   Fig. 1B. —6-month-old girl who presented with recurrent left lower lobe pneumonia. At surgery, patient was found to have intralobar sequestration with anomalous arterial vessel arising from thoracic aorta and anomalous venous drainage into left atrium. Axial CT image obtained at level higher than A shows that vein cannot be clearly separated from surrounding inflammation.

View larger version (50K): [in a new window]   Fig. 1C. —6-month-old girl who presented with recurrent left lower lobe pneumonia. At surgery, patient was found to have intralobar sequestration with anomalous arterial vessel arising from thoracic aorta and anomalous venous drainage into left atrium. Posterior 3D volume-rendered image shows anomalous arterial supply (arrow) from descending aorta to sequestered lung (S) and anomalous venous drainage (arrowhead) to left atrium.

View larger version (108K): [in a new window]   Fig. 2A. —6-month-old boy with abnormal findings on chest radiograph. At surgery, patient was found to have extralobar sequestration with anomalous arterial vessel arising from celiac artery and anomalous venous drainage into right atrium. Axial CT image shows anomalous arterial vessel (arrowhead) arising from celiac artery. A = abdominal aorta.

View larger version (62K): [in a new window]   Fig. 2B. —6-month-old boy with abnormal findings on chest radiograph. At surgery, patient was found to have extralobar sequestration with anomalous arterial vessel arising from celiac artery and anomalous venous drainage into right atrium. Axial CT image shows anomalous vein (arrowheads) arising from sequestered lung (S) and crossing midline to right hemithorax.

View larger version (73K): [in a new window]   Fig. 2C. —6-month-old boy with abnormal findings on chest radiograph. At surgery, patient was found to have extralobar sequestration with anomalous arterial vessel arising from celiac artery and anomalous venous drainage into right atrium. Axial lung window CT image shows anomalous vein (arrowheads) arising from sequestrated lung (S) and crossing midline to right hemithorax via cystic adenomatoid malformation (arrows).

View larger version (69K): [in a new window]   Fig. 2D. —6-month-old boy with abnormal findings on chest radiograph. At surgery, patient was found to have extralobar sequestration with anomalous arterial vessel arising from celiac artery and anomalous venous drainage into right atrium. Three-dimensional volume-rendered image obtained from anteroinferior view shows course of anomalous artery (curved arrow) arising from celiac artery and anomalous vein (straight arrows) crossing midline. Association of vein and cystic adenomatoid malformation is seen better on lung window image (C). RA = right atrium, S = sequestered lung.

View larger version (130K): [in a new window]   Fig. 3A. —6-day-old girl with abnormal findings on prenatal sonography, which showed mass in left lower hemithorax. Suspected extralobar sequestration was based on CT evidence of venous drainage into portal vein. Axial CT image shows small vessel (arrowhead) arising from aorta (A).

View larger version (144K): [in a new window]   Fig. 3B. —6-day-old girl with abnormal findings on prenatal sonography, which showed mass in left lower hemithorax. Suspected extralobar sequestration was based on CT evidence of venous drainage into portal vein. Axial CT image obtained through upper abdomen shows tiny vein (arrowhead) adjacent to left portal vein (curved arrow). This small vein was recognized as vein draining from sequestration only in retrospect.

View larger version (116K): [in a new window]   Fig. 3C. —6-day-old girl with abnormal findings on prenatal sonography, which showed mass in left lower hemithorax. Suspected extralobar sequestration was based on CT evidence of venous drainage into portal vein. Coronal maximum-intensity-projection CT image shows small vein (arrows) arising from sequestered lung (S) draining into portal vein (arrowhead).

View larger version (119K): [in a new window]   Fig. 3D. —6-day-old girl with abnormal findings on prenatal sonography, which showed mass in left lower hemithorax. Suspected extralobar sequestration was based on CT evidence of venous drainage into portal vein. Coronal 3D volume-rendered image shows small anomalous artery arising from abdominal aorta (curved arrow) and also clearly shows anomalous vein (straight arrow) draining into portal vein (arrowheads). S = sequestered lung.

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