CTICasesInfected Bronchopulmonary Sequestration with Bronchial Atresia
Imaging findings
CT of the chest and upper abdomen demonstrates a large, dense right lower lobe mass containing cystic spaces, tubular structures, and dystrophic calcifications. Coronal and sagittal reformats demonstrate a prominent systemic arterial feeder arising directly from the superior mesenteric artery (SMA), which crosses the diaphragm to supply the lesion. Comparison with a prior CT scan shows a pre-existing congenital lesion characterized by a hypovascular area with a lack of normal airways, dilated communicating bronchi, and a large systemic artery, representing a hybrid bronchopulmonary sequestration and bronchial atresia that subsequently became infected and fluid-filled.
Key takeaways
Congenital lung lesions are frequently hybrid anomalies containing elements of both bronchopulmonary sequestration and bronchial atresia. While asymptomatic congenital lesions may be monitored, they can become infected in adulthood, leading to a "socked-in" inflammatory mass with cystic spaces and calcifications. Identifying the anomalous systemic arterial supply, which can arise from abdominal branches like the superior mesenteric artery, is crucial for establishing the diagnosis and planning potential surgical resection to avoid catastrophic hemorrhage.
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