CTICasesAnomalous Systemic Arterial Supply to a Normal Lung
Imaging findings
CT angiography in a 30-year-old man demonstrates a large anomalous vessel arising directly from the descending thoracic aorta, supplying the left lower lobe basilar segments. The left lower lobe has normal bronchial anatomy (distinct from intralobar sequestration). The anomalous artery drains into a dilated left inferior pulmonary vein, creating a systemic-to-pulmonary left-to-left shunt. The left ventricle is markedly dilated, consistent with chronic volume overload.
Key takeaways
Anomalous systemic arterial supply to a normal lung (ASASL) is a rare congenital vascular anomaly in which an aberrant systemic artery supplies a morphologically normal lung with intact bronchial supply, as opposed to pulmonary sequestration where the bronchial supply is also absent. The anomalous vessel creates a left-to-left shunt leading to left ventricular volume overload. Surgical or endovascular correction is indicated for significant shunt fraction.
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