CTICasesPseudosequestration from Acquired Systemic Arterial Supply
[...]. Pseudosequestration from Acquired Systemic Arterial Supply. CTICases. Published September 11, 2026. https://cticases.com/c/yr85y
Imaging findings
A chronic basal consolidation was finally imaged with contrast. Rather than a single dominant feeding vessel and with nothing arising directly from the descending aorta, numerous small tortuous vessels crossed the diaphragm into the affected lower lobe, arising from conspicuously hypertrophied inferior phrenic artery branches, one of them strikingly corkscrewed. Lung windows showed a small cavity, mildly abnormal parenchyma with probable prior empyema and a little bronchiectasis. The patient had presented with hemoptysis at one point.
Key takeaways
Systemic arterial supply to the lung is not always congenital. Chronic parenchymal or pleural inflammation recruits systemic collaterals, and the acquired pattern is multiple small tortuous vessels from intercostal, internal mammary or inferior phrenic arteries rather than the single large feeder of a true sequestration. These collaterals carry systemic pressure and are a real cause of hemoptysis. Pseudosequestration belongs in every teaching session on sequestration. The persistent claim that all intralobar sequestrations are acquired traces to large surgical pathology series that only ever received infected, resected specimens, a selection bias that prenatal ultrasound detection of feeding vessels off the aorta has since undercut.
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