Developmental Lung Anomalies in the Adult: Radiologic-Pathologic Correlation

Abstract

Encountering a developmental lung anomaly in the adult can be a challenge, as the abnormality may be mistaken for something more sinister. The common anomalies encountered are classified into three broad categories: bronchopulmonary (lung bud) anomalies, vascular anomalies, and combined lung and vascular anomalies. The imaging features of these developmental anomalies at conventional radiography, ventilation-perfusion lung nuclear scanning, angiography, computed tomography, and magnetic resonance imaging are useful in differential diagnosis of thoracic lesions. Lung bud anomalies include agenesis, congenital bronchial atresia, congenital lobar emphysema, congenital cystic adenomatoid malformation, pulmonary bronchogenic cysts, tracheal or pig bronchus, and accessory cardiac bronchus. Vascular anomalies include interruption or absence of a main pulmonary artery, anomalous origin of the left pulmonary artery from the right, anomalous pulmonary venous drainage (partial or complete), and pulmonary arteriovenous malformation. Combined lung and vascular anomalies include the hypogenetic lung (scimitar) syndrome and bronchopulmonary sequestration, both intralobar and extralobar.

Lung Sequestration in an Octogenarian Male

“…During the arterial phase of the contrasted CT scan, the feeding vessel, which commonly originates from the thoracic or supraceliac abdominal aorta may become visible, allowing accurate diagnosis. 2,8,11 In our case we opted for aortic angiography. Huang et al reported on the use of Doppler sonography in the diagnosis of pulmonary sequestration in another octogenarian patient, however, they subsequently confirmed findings on CT angiography.…”

“…1 Blood supply originates from the aorta or various peripheral arteries. 1,2 It is also referred to as cystic lung disease. The intralobar type accounts for approximately 75% of cases; extralobar pulmonary sequestration accounts for 25% of cases, is located extrapulmonarily and forms its own visceral pleura.…”

Modern imaging of the tracheo-bronchial tree

“…At expiration, 90% or more patients show signs of collapse (malacia) with or without airtrapping. Calcifications in the airway walls may be seen in approximately 40% of patients [43,44] . CT is particularly useful for the planning of interventional procedures, such as stent placement, and also for follow-up in patients undergoing anti-inflammatory treatment.…”

“…Pulmonary artery sling is a condition in which the left pulmonary artery arises from the right main pulmonary artery [44] . As the vessel courses to the left lung, it passes between the trachea and esophagus, giving rise to the potential compression of the trachea [53] .…”

Unique Approach to Diagnosing and Treating Congenital Bronchial Atresia (CBA): A Case Series

“…Bronchial atresia is believed to result from the insufficient supply of blood to the bronchial bud during embryologic development. [6,7]. Frequently, a mucocele will develop distal to the atretic airway due to recurrent infections.…”