Anomalous systemic artery supply to the left basal lung with arterial dissection of the feeding artery: a case report and literature review

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Case Report

Anomalous systemic artery supply to the left basal lung with arterial dissection of the feeding artery: a case report and literature review

https://doi.org/10.21203/rs.3.rs-4439106/v1

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Anomalous systemic arterial supply to the left basal lung is a rare congenital abnormality and is even rarer when associated with arterial dissection of the feeding artery. Herein, we report a young patient who was hospitalized with sudden chest pain, which proved to be an abnormal thoracic aorta supplying blood to the basal segment of the left inferior lobe of the lung, with the supply artery dissection. It hasn't been reported as far as we know. The patient was successfully surgically resected and recovered well at follow-up.

Anomalous Systemic Artery

Pulmonary Sequestration

Arterial Dissection

CT angiography

Case Report

The Anomalous systemic arterial supply to the normal left lower lung lobe mainly originate from the descending aorta, supplying bronchi and lung parenchyma and reaching the normal left lower lobe. This abnormality had previously been classifed as a type of pulmonary sequestration by Pryce ^[1]. However, at present, this type of abnormality is considered as a distinct disease concept and is differentiated from pulmonary sequestration, on the basis of absence or presence of bronchial abnormalities. We describe a rare case of anomalous systemic arteries supplying the lower left lung lobe with artery dissection of the supplying artery, the lesion was be successful surgical resection. To improve the understanding of the disease, which can be diagnosised correctly through CTA find anomalous systemic arteries supply.

A 35-year-old man presented to our hospital with sudden chest and back pain after running last night, tearing pain, accompanied by chest tightness, shortness of breath symptoms. The patient had no remarkable medical history, and a physical examination revealed good health. Chest computed tomography (CT) showed tortuous vascular shadows in the lower lobe of the left lung surrounded by patchy ground-glass density shadows, and the distribution of the bronchial tree in the lower lobe of the left lung was normal (Fig. 1). CT angiography (CTA) showed a thick, tortuous, malformed artery originating from the thoracic aorta in the left lower lobe of the lung (Fig. 2a), with striated endocardial flap shadows in the supplying artery, forming a true or false lumen (Fig. 2b-c). Maximum intensity projection (MIP) reconstruction of the pulmonary artery vessels showed normally distributed pulmonary artery branches in the lower lobe of the left lung (Fig. 3). Laboratory test results were as follows: white blood cell count, 9.1×10⁹/L; ultrasensitive C-reactive protein, 30.8 mg/L. Three days after admission for anti-infective treatment, the patient underwent thoracoscopic resection of the left lower lobe of the lung. During the operation, the abnormal blood-supplying artery was found to originate from the thoracic aorta, the widest part of which was 1.2 cm in diameter, and the distal part was an aneurysm-like dilatation; the entire left lower lung exhibited solid atelectasis; therefore, a complete resection of the left lower lobe was performed (Fig. 4). Chest CT performed six months later revealed no obvious abnormalities.

The aetiology of anomalous systemic arterial supplying the normal left lower lobe of the lungs is unclear, and it may be related to the lack of degenerative remnants of the primitive aortic branches supplying the pulmonary blastema during the embryonic period in the pre-aortic developmental stage^[2]. The main clinical symptoms are haemoptysis and shortness of breath after an activity^[3]. The acute chest pain in our patient was considered to be related to the formation of arterial dissection of the blood-supplying artery. Prolonged vascular hypertension may have led to the thickening, calcification and elasticisation of the vessel wall, causing the formation of an aneurysm and arterial entrapment ^[4、5].

The imaging features of the abnormal systemic artery supplying the normal left lower lobe of the lung include the following: ①The abnormally thick systemic artery originates from the thoracic aorta or abdominal aorta. ②Absence of the pulmonary artery in the affected area (complete type) and normal pulmonary artery in the affected area, with dual blood supply from the body artery and pulmonary artery (incomplete type). ③ Normal lung development with continuous bronchial tubes. ④Normal pulmonary venous drainage ^[2、6]. The imaging findings of this patient are consistent with the literature reports, it is a rare incomplete type, and complicated with arterial dissection of the feeding artery.

Clinical misdiagnosis of pulmonary sequestration requires differentiation. Lobectomy is the treatment of choice for pulmonary sequestration^[7、8], whereas abnormal body arteries supplying the normal left lower lobe of the lung can be treated by thoracoscopic lobectomy, vascular interventional embolisation, or vascular anastomosis, depending on the diameter of the abnormal body arteries and clinical symptoms^[4] .

Referring to the pulmonary sequestration treatment, timely surgical treatment should be considered for mostpatients, especially for patients with recurrent pulmonary infection or cancer that cannot be excluded ^[8]. Therefore, we should pay particular attention to the unusual supplying arteries. We should tightly suture the tissue which abnormal supplying arteries could not be excluded from, so as to prevent extensive bleeding. It is important to determine the vascular anatomy of the supplying artery by CTA or DSA before surgery, especially when preparing for interventional embolization, because sometimes there is more than one supplying artery. Compared with surgical treatment, interventional therapy and VATS were more patient friendly and less invasive^[8–11]. But coil embolization of the anomalous arterial supply can cause early postoperative pulmonary infarction^[11].Finally, the patient underwent thoracoscopic resection of the left lower lobe of the lung and recovered well after a six-months follow-up.

Anomalous systemic arterial supply to the left basal lung is a rare congenital abnormality and is even rarer when associated with arterial dissection of the feeding artery. Imaging features of the lower lobe of the normal left lung with anomalous systemic arterial supply are more characteristic, Especially CT-enhanced scanning or CTA reconstruction techniques aid in definitive diagnosis. However, differentiation from pulmonary sequestration is needed to reduce the need for unnecessary invasive investigations and adopt a more optimal therapeutic approach.

CT=Computed tomography; CTA=Computed tomography angiography; MIP=Maximum intensity projection; VR=Volume rendering; CPR=Curved planar reformation; DSA=Digital subtraction angiography; VATS=Video-assisted thoracoscopic surgery

Acknowledgements

None.

Conflict of interest

The authors declare that there is no conflict of interest.

Authors’ contributions

MLP drafting of the manuscript; YKL review and editing, final approval of the version to be submitted; YZQ,XRMand WL contributed to the discussion of the results and to the revision of the manuscript; HWB performed thoracoscopic surgery and recorded the procedure. All authors read and approved the final manuscript.

Funding

This study was supported by the Health Science and Technology Program of the Shaoxing City (No. 2022KY070).

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Luping Ma, Wenbin Hu and Kelin Yao will make the data available to the readers.

Ethics approval and consent to participate

The Ethics Committee of the Afliated Hospital of Shaoxing University approved the study.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Competing interests

The authors declare that they have no competing interests.

Author details

1.Department of Radiology, the Affiliated Hospital of Shaoxing University(Shaoxing Municipal Hospital), Shaoxing, Zhejiang 312000；2.Department of Cardiothoracic surgery, the Affiliated Hospital of Shaoxing University(Shaoxing Municipal Hospital), Shaoxing, Zhejiang 312000

*Corresponding author: Dr Kelin Yao, Department of Radiology, the Affiliated Hospital of Shaoxing University(Shaoxing Municipal Hospital) . No.999 Zhongxing South Road, Shaoxing, Zhejiang 312000, P.R. China. Corresponding Email: [email protected]

PRYCE DM. Lower accessory pulmonary artery with intralobar sequestration of lung; a report of seven cases. J Pathol Bacteriol. 1946 Jul;58(3):457-67. PMID: 20283082.
Hirai T, Ohtake Y, Mutoh S, Noguchi M, Yamanaka A. Anomalous systemic arterial supply to normal basal segments of the left lower lobe. A report of two cases. Chest. 1996; 109: 286–289. doi:10.1378/chest.109.1.286
Wu Z, Xu B, Zhou D, Yang X. Anomalous systemic arterial supply to the left lower lung lobe: A case report. Front Med (Lausanne). 2022; 9: 904431. doi:10.3389/fmed.2022.904431
Jiang S, Shi JY, Zhu XH, et al. Endovascular embolization of the complete type of anomalous systemic arterial supply to normal basal lung segments: a report of four cases and literature review. Chest. 2011; 139: 1506–1513. doi:10.1378/chest.10-1022
Ebihara M, Fujimori S, Suzuki S, Yotsumoto T, Kikunaga S, Ohtsuka R, Matsuyama S. Anomalous systemic arterial supply to the left basal lung with a calcified abnormal vessel: a case report. Surg Case Rep. 2022 Jun 22;8(1): 121. doi: 10.1186/s40792-022-01469-8. PMID: 35729289; PMCID: PMC9213598.
Kim TS, Lee KS, Im J-G, Goo JM, Park JS, Kim JH. Systemic arterial supply to the normal basal segments of the left lower lobe: radiographic and CT findings in 11 patients. Thorac Imaging. 2002; 17: 34–39. doi:10.1097/00005382-200201000-00004.
Chakraborty RK, Modi P, Sharma S. Pulmonary Sequestration. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532314/
Wei Y, Li F. Pulmonary sequestration: a retrospective analysis of 2625 cases in China. Eur Cardiothorac Surg. 2011 Jul; 40(1): e39-42. doi: 10.1016/j.ejcts.2011.01.080. Epub 2011 Apr 2. PMID: 21459605.
Wan IY, Lee TW, Sihoe AD, Ng CS, Yim AP. Video-assisted thoracic surgery lobectomy for pulmonary sequestration. Ann Thorac Surg. 2002;73:639-640.
Lee KH, Sung KB, Yoon HK, Ko GY, Yoon CH, Goo HW, Kim EA, Kim KS, Pi SY. Transcatheter arterial embolization of pulmonary sequestration in neonates: long-term follow-up results. Vasc Interv Radiol. 2003;14:363-367.
Wu Z, Xu B, Zhou D, Yang X. Anomalous systemic arterial supply to the left lower lung lobe: A case report. Front Med (Lausanne). 2022 Jul 22; 9: 904431. doi: 10.3389/fmed. 2022.904431. PMID: 35935777; PMCID: PMC9354403.

No competing interests reported.

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Anomalous systemic artery supply to the left basal lung with arterial dissection of the feeding artery: a case report and literature review

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