肺隔离症1例

患者女,17岁。反复咳嗽、咳黄痰伴间断性咯血2年,左上腹痛半年。外院一直以肺炎、支气管扩张等疾病对症治疗,症状迁延。查体:左下肺呼吸音略低,左上腹部轻压痛,余正常。胸部CT检查(图1):左侧胸腹腔交界部囊性占位(肺隔离症不除外);左肺下叶支扩(轻度);腹部MRI检查(图2):左肾后上方、脾脏内侧占位,考虑为炎性病变。初步诊断:胸腔内占位;腹膜后肿物。2006年3月行手术治疗,术中见病变于左肺下叶,包膜完整,呈囊性,侵蚀膈肌,开膈肌探查肿物8cm×6cm大小,向下延伸至左肾上腺,有两支细小动脉来自腹主动脉,未发现异常回流静脉。断异常动脉,切除左…     

肺隔离症1例

我院CT诊断肺隔离症1例,并手术证实,现报告如下. 患者男性,41岁.体检偶然发现右下肺肿块,无明显临床症状.正侧位胸片示:右下肺野见团块状密度增高影,边界清.CT平扫所见:右下肺脊柱旁类圆形软组织密度肿块影,边界清晰光滑,大小约94mm×106mm,其密度均匀,CT值约38HU,肿块周围见少量斑片状高密度影,边缘模糊.     

Pulmonary sequestration: the value of ultrasound

A child presented with a chest infection. A chest radiograph showed consolidation in the left lung base. This failed to clear in spite of adequate antibiotic therapy. Ultrasound examination (real-time) suggested pulmonary sequestration, and an aberrant blood supply was demonstrated. Subsequent angiography, surgery and pathological examination of the resected segment confirmed this.     

Pulmonary sequestration of the upper lobe in children

Intralobar pulmonary sequestration in an upper lobe is uncommon. The radiologic manifestations are similar to lower lobe lesions. A case is presented in which there are features of both intralobar and extralobar sequestration.     

Pulmonary sequestration: What the radiologist should know

Pulmonary sequestration consists of a nonfunctioning mass of lung tissue, either sharing the pleural envelope of the normal lung (intralobar) or with its own pleura (extralobar), lacking normal communication with the tracheobronchial tree and receiving its arterial supply by one or more systemic vessels. It is the second most common congenital lung anomaly according to pediatric case series, but its real prevalence is likely to be underestimated, and imaging plays a key role in the diagnosis and treatment management of the condition and its potential complications. We will give a brief overview of the pathophysiology, clinical presentation and imaging findings of intra- and extralobar pulmonary sequestration, with particular reference to multidetector computed tomography as part of a powerful and streamlined diagnostic approach.     

Pulmonary sequestration diagnosed by contrast enhanced three-dimensional MR angiography

Pulmonary sequestration is a congenital bronchopulmonary foregut malformation in which a segment of lung parenchyma is not connected to the tracheobronchial tree. This abnormal segment receives a blood supply from the systemic circulation. Multiple imaging modalities have been used to demonstrate the vascular anatomy of the sequestration. Different magnetic resonance angiography (MRA) techniques have been employed in the identification of these anomalous vessels. We report a case of pulmonary sequestration diagnosed by MRI with the use of contrast enhanced three-dimensional MRA.     

Pulmonary sequestration in the adult. Diagnostic contribution of angiography

PURPOSE: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients. MATERIAL AND METHODS: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. RESULTS: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. CONCLUSIONS: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.     

Pulmonary sequestration: a 131I whole body scintigraphy false-positive result

A 35-year-old woman affected by a well-differentiated papillary thyroid carcinoma was referred to our hospital to perform a ¹³¹Iodine (¹³¹I) whole body scintigraphy for restaging purpose. The patient had been previously treated with total thyroidectomy and three subsequent doses of ¹³¹I for the ablation of a remnant jugular tissue and a suspected metastatic focus at the superior left hemi-thorax. In spite of the previous treatments with ¹³¹I, planar and tomographic images showed the persistence of an area of increased uptake at the superior left hemi-thorax. This finding prompted the surgical resection of the lesion. Histological examination of the surgical specimen showed the presence of a pulmonary tissue consistent with pulmonary sequestration. Even though rare, pulmonary sequestration should be included in the potential causes of false-positive results of radioiodine scans.     

Pulmonary hydatid disease mimicking sequestration: differentiation on magnetic resonance imaging

A case of hydatid disease of the lung proven by thoracotomy and histopathological evaluation is described. It was clinically and radiologically suggestive of a complicated pulmonary sequestration or non-resolving consolidation.     

一例成人颈部肺隔离症的影像表现

患者女,43岁.颈痛、咽痛伴发热10 d于2008年8月18日入院,体温37.7～38.0℃.体检:颈部无抵抗,无颈静脉怒张,气管居中.甲状腺局部压痛,未触及肿块及血管杂音.入院抗感染治疗1周,患者体温下降,颈部疼痛减轻.     

螺旋CT三维重建在肺隔离症诊断中的应用

目的 评价螺旋CT三维重建在肺隔离症诊断中的作用。方法 对10例肺隔离症进行回顾性分析。2例行肺血管造影、2例手术、6例CT血管成像显示病变由异常体动脉供血。所有检查采用Philips Tomoscan SR 7000或GE LighhtSpeed Plus多层面CT扫描机，将图像传输至工作站进行三维重建。图像经2位(或2位以上)放射科医师阅片分析。结果 10例肺隔离症病灶1例位于右下叶，9例位于左下叶，异常体动脉供血8例来自胸主动脉，2例来自腹腔干。CT平扫表现为斑片状阴影4例，肺门肿块并邻近肺血管影增多迂曲3例，肺气肿区内条状高密度影2例，多囊融合肿块影1例。10例增强扫描有9例显示异常体动脉供血，其平均直径9．7mm，7例显示引流静脉。采用最大密度投影及曲面重建可显示异常体动脉、引流静脉及其与病变结构的关系，表面阴影成像及容积重现可显示异常血管。结论 螺旋CT增强扫描三维重建可显示异常供血动脉及引流静脉，是诊断肺隔离症的首选检查方法。     

Pulmonary sequestration: diagnosis with color Doppler sonography and a new theory of associated hydrothorax

The diagnosis of pulmonary sequestration has traditionally relied on angiographic demonstration of a systemic artery to the sequestered lung tissue. Rarely, extralobar sequestration can be associated with tension hydrothorax, which in the past has invariably led to fetal hydrops and death. The authors report the cases of three infants who had initially undergone color and spectral Doppler analysis; in two of them, extralobar sequestrations were associated with congenital hydrothorax. All three patients underwent surgical resection and histopathologic evaluation of their sequestrations. On the basis of the findings, the authors believe that torsion of the sequestration occludes the efferent venous and lymphatic channels, initiating the accumulation of pleural fluid and subsequent hydrops through systemic venous obstruction. Color Doppler made possible the identification of minute feeding vessels, obviating further diagnostic studies.     

Pulmonary sequestration: demonstration of blood supply with 2D and 3D MR angiography

Pulmonary sequestration is a relatively rare but clinically significant congenital anomaly. This disease is a spectrum of disorders involving the pulmonary airways, the arterial supply to the lungs, the lung parenchyma and its venous drainage. Traditionally, the diagnosis of pulmonary sequestration has been made definitively with arterial angiography. It is imperative for the preoperative evaluation that the arterial supply and venous drainage of the sequestered segment is identified. Several cases of MR diagnosis and preoperative evaluation of pulmonary sequestration and blood supply have been reported. In this case, MR imaging was able to provide important information about systemic blood supply via intercostal arteries and regular venous drainage. Furthermore this imaging technique revealed a second pulmonary sequestration in the dorsal phrenicocostal sinus that was not diagnosed before.