Pulmonary sequestration (intralobar)

The postnatal
differential diagnosis of four patients with antenatal diagnosis of congenital pulmonary airways malformation (CPAM). Wedge-shaped density present at left base medially behind the heart.
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The postnatal
differential diagnosis of four patients with antenatal diagnosis of congenital pulmonary airways malformation (CPAM). 30mm x 14mm lesion with heterogeneous enhancement in the posterior basal segment of the left lower lobe. The lesion is supplied by a systemic artery arising from the distal descending thoracic aorta.
www.eurorad.org • CC by-nc-sa-4.0
The postnatal
differential diagnosis of four patients with antenatal diagnosis of congenital pulmonary airways malformation (CPAM). 30mm x 14mm lesion with heterogeneous enhancement in the posterior basal segment of the left lower lobe. The lesion is supplied by a systemic artery arising from the distal descending thoracic aorta.
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Intralobar pulmonary sequestration (ILS) is a subtype of pulmonary sequestration.

Clinical presentation

Patients usually present before the third decade with recurrent infection.

Pathology

It is the commoner type of pulmonary sequestration (four times commoner than extralobar sequestration), accounting for 75% of all sequestrations and is characterized by the sequestration surrounded by normal lung tissue without its own pleural covering.

There is increasing data to support the concept of sequestrations stemming from recurrent infections that produce aberrant arterial vessels arising from the aorta . Feeding vessels include branches from the thoracic aorta (75%), abdominal aorta, intercostal artery or multiple arteries.

Location

There is strong predilection towards the lower lobes (predominantly left lower lobe).

Treatment and prognosis

Surgical excision is the mainstay of treatment.

Differential diagnosis

On imaging, possible differential considerations include: