Anomalous systemic arterial supply to the basal segment of the lung with giant aberrant artery: a case report

Abstract

Background Anomalous systemic arterial supply to the basal segment of the lung (ABLL) is a relatively rare congenital anomaly characterized by aberrant systemic arterial blood flow to the basal segment of the lung. We experienced a rare presentation of ABLL, in which a giant aberrant artery with the same dimensions as that of the descending aorta flowed from the celiac artery to left lower lobe. Case presentation An otherwise healthy 42-year-old man was referred to our department due to an abnormal chest X-ray. Enhanced computed tomography revealed a huge and winding aberrant artery with mural thrombus originating from the celiac artery and perfusing into the left lower lobe. We diagnosed giant ABLL and considered possible concomitant pulmonary arteriovenous fistula. The diameter of the aberrant artery was > 30 mm and high-pressure flow was assumed; therefore, we performed staged resection of the left lower lobectomy including division of the aberrant artery at the pulmonary ligament and subsequent embolization of the remnant arterial flow uneventfully. Pathologically, the aberrant artery was abundant with elastic fibers, and dissections of the tunica media and mural thrombus were observed; however, arteriovenous fistula was not confirmed. At 6 postoperative months, enhanced computed tomography showed the aberrant artery to be completely occluded without any symptoms. Conclusions We present a case of ABLL that was successfully managed by surgical resection of the left lower lobe with most of the giant aberrant artery and subsequent embolization of the remnant portion. Our study demonstrates that a staged surgical therapy is an acceptable approach for ABLL in case of complication with a giant aberrant artery.

Role of indocyanine green in anomalous arterial supply to the normal dorsobasal segment of the lung

“…Wei et al examined 2625 cases of PS; only one case originated from the celiac artery, an extremely rare finding [2]. Even in Japan, there were only 10 reported cases in the last 30 years (Table 1) [3,4]. Seven patients were male and three were female, with an average age of 26.2 years.…”

Vascular Anatomy in Congenital Lung Lesions—Description and Classification

“…It is noteworthy that, atypical systemic arterial supply to parts of the lung may also occur in the absence of congenital lung lesions. In these rare cases, atypical systemic arteries supply normal basal segments of the right or left lung ( 2 , 3 ).…”

Anomalous systemic arterial supply to the basal segment of the lung presenting with haemoptysis in the third trimester of pregnancy

“…Surgical resection with ligation of the anomalous arteries has been the treatment of choice historically, for both symptomatic and asymptomatic cases of ABLL and PS. 9, 21 An alternative treatment is exclusion of the aberrant arterial supply via an endovascular approach, utilising various occlusion devices, resulting in the embolised lesion undergoing ischaemia, infarction and even disappearance. 22 No head-to-head studies have been performed comparing these approaches.…”

“…Traditionally management involved surgical resection of the aberrant artery and lung resection, however transarterial embolisation has recently been utilised for certain cases. [8][9][10] There has been a single case report of ABLL 11 and few reports of the related condition of PS presenting for the first time in pregnancy. 12,13 We describe a case of ABLL presenting with haemoptysis in the third trimester.…”

“…Traditionally management involved surgical resection of the aberrant artery and lung resection, however transarterial embolisation has recently been utilised for certain cases. 8–10…”