CTICasesThrombosed Anomalous Systemic Arterial Supply to the Lung ("Lonely Bronchus" Sign)
Imaging findings
An incidental tubular, calcified structure is identified in the lower mediastinum adjacent to the descending aorta on a CT obtained for an unrelated indication; it is not opacified with contrast and branches into adjacent lung on the lung windows, without an identifiable point of attachment to the aorta. A corresponding bronchus in that region lacks its expected accompanying pulmonary artery branch (the "lonely bronchus" sign).
Key takeaways
A non-opacified, calcified tubular structure branching into lung, without contrast attachment to the aorta, is consistent with a chronically thrombosed anomalous systemic arterial supply to the lung; the absence of any associated bronchial atresia or parenchymal abnormality argues against a variant of pulmonary sequestration, and the accompanying "lonely bronchus" sign -- a bronchus without its expected pulmonary artery companion -- may be a clue to the presence of an anomalous systemic supply nearby.
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