Ann Thorac Surg 2004;78:1477
© 2004 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
False Aneurysm in Pulmonary Sequestration
Poo-Sing Wong, FRCS (CTh)a,*,
Aneez D. B. Ahmed, FRCSa,
Chuen-Neng Lee, FRACSa
a Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, Singapore, Singapore
* Address reprint requests to Dr Wong, Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
surwps{at}nus.edu.sg
A 35-year-old man had a past history of repeated left lower lobe pneumonia and presented with a 2-week history of fever, cough, and dyspnea. Chest radiograph showed consolidation of the left lower lobe with pleural effusion. Computed tomography showed a large aneurysm measuring 15 cm in diameter in the left lower lobe with extensive thrombus (Fig 1). Magnetic resonance angiogram showed a 13-mm diameter feeding vessel (arrow) from the left lateral aspect of the distal descending aorta (Fig 2). The draining vessel was not well visualized.
The diagnosis was therefore one of aneurysm formation from the feeding artery of the lung sequestration with rupture. Aortogram showed the origin of the feeding vessel to arise from the aorta at the level of the 10th thoracic vertebra. An attempt was made to embolize this feeding vessel, but the flow through this systemic artery was deemed too high to allow safe placement of the coil. The patient proceeded to surgery, during which the feeding systemic vessel was identified, divided, and transfixed at its origin. Venous drainage was to a common pulmonary vein. There was no communication between the sequestrated lobe and the gastrointestinal tract. Extreme care was taken during mobilization of the mass as the thrombus within the aneurysm may embolize into the left atrium.
The decision was made to perform a pneumonectomy, as the oblique fissure was densely fused. The resected bisected specimen showed lower lobe intralobar pulmonary sequestration with a large cavity measuring 15 cm in diameter with a laminated, organized thrombus (large arrow) that had a central area of fresh clot (small arrow) (Fig 3) as a result of rupture of the systemic feeding artery. The patient was discharged from hospital 11 days after surgery. He was back to work 3 months after the operation.
