Incidental Finding - the Discovery of a Bronchopulmonary Foregut Malformation Through Investigations for Crohn's Disease

Overview

Journal J Radiol Case Rep

Specialty Radiology

Date 2017 Jun 2

PMID 28567181

Authors

Humza Mahmood

Andrew Plumb

Roser Vega

Alastair Windsor

Affiliations

Soon will be listed here.

Abstract

Pulmonary sequestration (PMS) is a rare bronchopulmonary malformation. It has an incidence of between 0.15% to 1.7%. Likewise, cystic adenomatoid malformation (CCAM) is another relatively rare category of a bronchopulmonary malformation with a reported incidence of between 1 in 25,000 to 1 in 35,000. Moreover, a bronchopulmonary malformation with features allied to both of these forms is considered an even rarer entity. In general, bronchopulmonary malformations present with a range of non-specific symptoms. Radiological features can be non-specific yet distinctive when related to clinical features. Ultimately, definitive diagnosis depends upon histological assessment of lung tissue. We present an adult female with radiological features of both pulmonary sequestration and cystic adenomatoid malformation. This was an incidental finding unrelated to the patients presenting complaint. This case highlights the importance of using a structured and systematic approach when interpreting medical imagery.

References

Stocker J, Madewell J, DRAKE R . Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol. 1977; 8(2):155-71. DOI: 10.1016/s0046-8177(77)80078-6. View

Lee M, Lue H, Chiu I, Chiu H, Tsao L, Cheng C . A systematic classification of the congenital bronchopulmonary vascular malformations: dysmorphogeneses of the primitive foregut system and the primitive aortic arch system. Yonsei Med J. 2008; 49(1):90-102. PMC: 2615272. DOI: 10.3349/ymj.2008.49.1.90. View

GABRIELE O . Arterial supply to the lung via the celiac axis. Am J Roentgenol Radium Ther Nucl Med. 1970; 109(3):522-7. DOI: 10.2214/ajr.109.3.522. View

E McLean S, Pfeifer J, Siegel M, Jensen E, Schuler P, Hirsch R . Congenital cystic adenomatoid malformation connected to an extralobar pulmonary sequestration in the contralateral chest: common origin?. J Pediatr Surg. 2004; 39(8):e13-7. DOI: 10.1016/j.jpedsurg.2004.04.044. View

Laberge J, Flageole H, Pugash D, Khalife S, Blair G, Filiatrault D . Outcome of the prenatally diagnosed congenital cystic adenomatoid lung malformation: a Canadian experience. Fetal Diagn Ther. 2001; 16(3):178-86. DOI: 10.1159/000053905. View

Yoshitake S, Hayashi H, Osada H, Kawahara M . Emergency laparotomy helped the resection of an intralobar pulmonary sequestration with haemorrhagic shock. Eur J Cardiothorac Surg. 2012; 43(1):190-2. DOI: 10.1093/ejcts/ezs394. View

Sade R, CLOUSE M, ELLIS Jr F . The spectrum of pulmonary sequestration. Ann Thorac Surg. 1974; 18(6):644-58. DOI: 10.1016/s0003-4975(10)64417-7. View

Sfakianaki A, Copel J . Congenital cystic lesions of the lung: congenital cystic adenomatoid malformation and bronchopulmonary sequestration. Rev Obstet Gynecol. 2012; 5(2):85-93. PMC: 3410507. View

Samuel M, Burge D . Management of antenatally diagnosed pulmonary sequestration associated with congenital cystic adenomatoid malformation. Thorax. 1999; 54(8):701-6. PMC: 1745542. DOI: 10.1136/thx.54.8.701. View

10.

Karakas S, Morrison S, Soldes O . Unilateral Coexisting Intralobar and Extralobar Pulmonary Sequestrations. Radiol Case Rep. 2016; 3(3):171. PMC: 4897019. DOI: 10.2484/rcr.v3i3.171. View

11.

Shibano T, Endo S, Tetsuka K, Saito T, Kanai N, Yashiro T . Aberrant aneurysm of adult-type pulmonary sequestration: report of a case. J Thorac Dis. 2015; 7(3):E33-6. PMC: 4387417. DOI: 10.3978/j.issn.2072-1439.2015.02.15. View

12.

PRYCE D, SELLORS T, BLAIR L . Intralobar sequestration of lung associated with an abnormal pulmonary artery. Br J Surg. 2010; 35(137):18-29. DOI: 10.1002/bjs.18003513704. View

13.

Izzillo R, El Hajjam M, Qanadli S, Guichaux F, Mignon F, Caubarrere I . [Intralobar sequestration of the lung in an adult (type 1 of pryce). Treatment by coil embolization]. J Radiol. 2000; 81(9):996-9. View

14.

Biederer J, Mirsadraee S, Beer M, Molinari F, Hintze C, Bauman G . MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging. 2012; 3(4):373-86. PMC: 3481076. DOI: 10.1007/s13244-011-0142-z. View

15.

Mackenzie T, Guttenberg M, Nisenbaum H, Johnson M, Adzick N . A fetal lung lesion consisting of bronchogenic cyst, bronchopulmonary sequestration, and congenital cystic adenomatoid malformation: the missing link?. Fetal Diagn Ther. 2001; 16(4):193-5. DOI: 10.1159/000053907. View

16.

Cass D, Crombleholme T, Howell L, Stafford P, Ruchelli E, Adzick N . Cystic lung lesions with systemic arterial blood supply: a hybrid of congenital cystic adenomatoid malformation and bronchopulmonary sequestration. J Pediatr Surg. 1997; 32(7):986-90. DOI: 10.1016/s0022-3468(97)90383-3. View

17.

Wani S, Mufti G, Bhat N, Baba A . Pulmonary Sequestration: Early Diagnosis and Management. Case Rep Pediatr. 2015; 2015:454860. PMC: 4529943. DOI: 10.1155/2015/454860. View

18.

Carsin A, Mely L, Chrestian M, Devred P, de Lagausie P, Guys J . Association of three different congenital malformations in a same pulmonary lobe in a 5-year-old girl. Pediatr Pulmonol. 2010; 45(8):832-5. DOI: 10.1002/ppul.21068. View

19.

Naffaa L, Tank J, Ali S, Ong C . Bronchopulmonary sequestration in a 60 year old man. J Radiol Case Rep. 2014; 8(10):32-9. PMC: 4242150. DOI: 10.3941/jrcr.v8i10.2235. View

20.

Cheney L, Patel B, Lam A, Arbuckle S, Morris J, Holland A . Extralobar pulmonary sequestration in association with congenital cystic adenomatoid malformation: an unusual abdominal mass. ANZ J Surg. 2012; 81(7-8):556-8. DOI: 10.1111/j.1445-2197.2011.05807.x. View