CTICasesBilateral Congenital Anomalies: Left Sequestration with CPAM and Right Basilar Systemic Arterialization
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Imaging findings
Chest radiograph and CT reveal bilateral lower lobe abnormalities. On the left, there is a systemic feeding artery arising from the descending thoracic aorta supplying a soft tissue mass with cystic/bubbly features in the left lower lobe, consistent with a mixed bronchopulmonary sequestration and congenital pulmonary airway malformation (CPAM) lesion. On the right, a massive, tortuous systemic artery originates from the descending aorta and courses into the right lower lobe, which shows relatively normal lung parenchyma with large returning veins draining to a dilated inferior pulmonary vein, consistent with systemic arterialization.
Key takeaways
This case represents a rare combination of bilateral congenital bronchopulmonary anomalies: a mixed intralobar sequestration/CPAM on the left, and systemic arterialization of the right lung base without a sequestration component. Systemic arterialization of normal lung parenchyma introduces high-pressure systemic flow into a low-resistance pulmonary circuit, causing a left-to-left shunt that carries risks of high-output heart failure and hemoptysis. Embolization or resection must be carefully evaluated due to the risk of infarctions in large vascular territories.
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