A 59-year-old male smoker presented with recurrent attacks of blood-tinged sputum over 12 years. Imaging revealed a right lower lobe opacity and calcification. Further CT angiography identified a right intralobar pulmonary sequestration (ILS) receiving a dual arterial blood supply from the right pulmonary artery and abdominal aorta, with venous drainage into the right pulmonary vein. Pulmonary sequestration is a congenital malformation where non-functioning lung tissue receives a blood supply directly from the systemic circulation instead of the pulmonary arteries. Surgical resection is typically recommended to prevent infections, though recent options include video-assisted thoracoscopic surgery or arterial embolization of feeding vessels.

2. Case description
• Male patient 59 years old.Male patient 59 years old.
• Current smoker.Current smoker.
• Presented with recurrent attacks of bloodPresented with recurrent attacks of blood
tinged sputum (average 3 attacks/ year).tinged sputum (average 3 attacks/ year).
• First attack started 12 years ago.First attack started 12 years ago.

3. Case description
• The patient was first investigated in the
primary health care facility where chest X-
ray was done.
• He was diagnosed as a case of bronchitis
despite the obvious right paracardiac
opacity.

4. Chest X ray
Right paracardiac shadow

5. Case description
• The patient was treated with non specific
treatment.
• patient was admitted to a general hospital due to
another attack of hemoptysis with syncope.
• Thorax CT scan:
o Right lower lobe opacity with calcification.

6. CT of the chest
Right lower lobe opacity with calcification

7. Case description
• Due to the suspicious of malignancy:
ultrasonographic-guided aspiration was done twice.
• Pathological examination:
o Fibrous tissue with dilated vascular spaces.

8. Case description
• The patient was referred to the chest department
at the Mansoura university hospital for further
evaluation and bronchoscopy.
• After revision of the history and chest radiology,
pulmonary sequestration was suspected besides
other benign lung lesions.

9. Case description
• CT angiography:
o Right intralobular pulmonary sequestration.
o Dual arterial supply from right pulmonary artery
and multiple branches from abdominal aorta.
o The venous drainage into right pulmonary vein.

10. CT angiography
Dual arterial supply from right pulmonary artery and multiple branches
from abdominal aorta.

11. Pulmonary sequestration

12. Pulmonary sequestration (PS)
• Congenital lung malformation:
o A mass of abnormal, nonfunctioning pulmonary tissue
o No communication with tracheobronchial tree
o Receive blood supply from an anomalous systemic artery
(instead of pulmonary arterial system)
o Usually occur in the left lower lobe

13. Types of PS
Intralobar PS
75%
Within visceral pleura of a
pulmonary lobe
Diagnosis is usually done at the
second decade of life.
Recurrent infection is common.
Not associated with other
anomalies
Extralobar PS
25%
Accessory lobe : tissue has its own
pleura
Diagnosis is usually made in
neonates or infants.
Often asymptomatic
Often associated with other
anomalies:
• Diaphragmatic hernia
•Cardiac malformation
•Foregut anomalies

14. Types of PS
Intralobar PS
PS has visceral pleura of a lung lobe
Extralobar PS
PS has its own pleura

15. Types of PS
Intralobar PS
Cystic changes and infection are
common
Extralobar PS
Infection is less common

16. Radiological assessment

17. CT angiography
• Simultaneously visualize:
oArterial supply.
oVenous drainage.
oParenchymal involvement of PS.

18. MRI
• Demonstrates:
oLocation of the lesion.
oAberrant artery and venous drainage.

19. MRA
Extralobar PS. Arrows referred to Aberrant blood supply.

20. Management

21. Management
• Symptomatic patient:
o Surgical resection with proper identification and
ligation of the feeding vessels.

22. Management
• Asymptomatic patient:
o Surgery is recommended.
• Prevent recurrent infections and the unfavorable
cardiac influence caused by the existing
aortopulmonary shunt.

23. Management
• Recent modalities:
1. Video-assisted thoracoscopic surgery (VATS).
2. Arterial embolization of the feeding vessels.

24. Conclusion

25. • The interesting points in our
case
o The late presentation of the
patient (59 years old)
o Unusual right-sided ILS
o The double blood supply
from both pulmonary artery
and abdominal aorta.
Conclusion

26. Acknowledgments