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Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion.

Takeuchi K, Ono A, Yamada A, Toyooka M, Takahashi T, Shigematsu Y, Ohta M, Sagoh T - Pol J Radiol (2014)

Bottom Line: On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images.That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan.

ABSTRACT

Background: This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis.

Case reports: Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.

Conclusions: By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.

No MeSH data available.


Related in: MedlinePlus

Case 1. Contrast-enhanced chest CT. A solid mass with cyst and branching fluid collection is apparent above the right dorsal diaphragm.
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f1-poljradiol-79-145: Case 1. Contrast-enhanced chest CT. A solid mass with cyst and branching fluid collection is apparent above the right dorsal diaphragm.

Mentions: A healthy and asymptomatic 50-year-old woman showed suspected right pleural effusion on abdominal ultrasonography carried out for screening. Chest computed tomography (CT) showed a well-circumscribed dome-like solid mass with cysts and branching fluid collection above the right dorsal diaphragm (Figure 1). The abutting lung was displaced and slightly compressed by the mass, and internal structures were not connected to the mass. Laboratory data including tumor markers (carcinoembryonic antigen, 1.9 ng/mL; cytokeratin fragment, 1.4 ng/mL; Pro-gastrin-releasing peptide, 18.2 pg/mL) were all within normal limits. Magnetic resonance imaging showed the solid part of the mass as a region of inhomogeneous low signal intensity on T2-weighted images and enhanced strongly on contrast-enhanced T1-weighted imaging, while cysts and fluid collection within the mass were isointense with water on both T1- and T2-weighted images (Figures 2 and 3). On angiography, the mass was supplied by the dilated right inferior phrenic artery and showed strong enhancement but no drainage vein was detected. Extralobar pulmonary sequestration was suspected because of the presence of branching structures within the mass and the blood supply from the right inferior phrenic artery. Two days after preoperative embolization as operative support, the mass was resected by video-assisted thoracoscopic surgery. On surgical findings, an ectopic lung tissue-like mass was located above the right diaphragm, with its own pleural investment. The mass was connected to the diaphragm by a pedicle, without any connection to the normal lung, and was resected at the pedicle.


Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion.

Takeuchi K, Ono A, Yamada A, Toyooka M, Takahashi T, Shigematsu Y, Ohta M, Sagoh T - Pol J Radiol (2014)

Case 1. Contrast-enhanced chest CT. A solid mass with cyst and branching fluid collection is apparent above the right dorsal diaphragm.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4061149&req=5

f1-poljradiol-79-145: Case 1. Contrast-enhanced chest CT. A solid mass with cyst and branching fluid collection is apparent above the right dorsal diaphragm.
Mentions: A healthy and asymptomatic 50-year-old woman showed suspected right pleural effusion on abdominal ultrasonography carried out for screening. Chest computed tomography (CT) showed a well-circumscribed dome-like solid mass with cysts and branching fluid collection above the right dorsal diaphragm (Figure 1). The abutting lung was displaced and slightly compressed by the mass, and internal structures were not connected to the mass. Laboratory data including tumor markers (carcinoembryonic antigen, 1.9 ng/mL; cytokeratin fragment, 1.4 ng/mL; Pro-gastrin-releasing peptide, 18.2 pg/mL) were all within normal limits. Magnetic resonance imaging showed the solid part of the mass as a region of inhomogeneous low signal intensity on T2-weighted images and enhanced strongly on contrast-enhanced T1-weighted imaging, while cysts and fluid collection within the mass were isointense with water on both T1- and T2-weighted images (Figures 2 and 3). On angiography, the mass was supplied by the dilated right inferior phrenic artery and showed strong enhancement but no drainage vein was detected. Extralobar pulmonary sequestration was suspected because of the presence of branching structures within the mass and the blood supply from the right inferior phrenic artery. Two days after preoperative embolization as operative support, the mass was resected by video-assisted thoracoscopic surgery. On surgical findings, an ectopic lung tissue-like mass was located above the right diaphragm, with its own pleural investment. The mass was connected to the diaphragm by a pedicle, without any connection to the normal lung, and was resected at the pedicle.

Bottom Line: On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images.That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Fukui Red Cross Hospital, Fukui, Japan.

ABSTRACT

Background: This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis.

Case reports: Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions.

Conclusions: By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.

No MeSH data available.


Related in: MedlinePlus