Complex Mass at Right Lung Base
A 43-year-old nonsmoking man was admitted for evaluation of two masses at the right lung base. A mass was first noted on a routine chest radiograph 14 years previously (Fig 1). The patient underwent bronchoscopic examination at that time, which was reported as unremarkable. In view of the patients age and lack of symptoms, it was decided to follow the lesion with annual chest radiographs. The right lower lobe mass remained stable in size and appearance for nine years. avandia online
No interval films had been performed between 1983 and 1987, at which time a follow-up film showed a second mass superior to the previous mass (Fig 2). The original mass appeared unchanged. The patient remained asymptomatic. Noncontrast CT and transtho-racic needle aspiration biopsy of the new mass were performed on an outpatient basis for further evaluation. Purulent material was aspirated, which subsequently grew Pseudomonas aeruginosa. Following the biopsy, the patient developed fever, chills, and pleuritic right-sided chest pain which prompted admission to the hospital. A chest radiograph done at that time revealed a new’ large right pleural effusion. White blood cell count on admission was 12.8K with 80 percent segs, 8 percent lymphocytes, and 8 percent monocytes. A chest tube was placed and 1,700 ml of bloody fluid was withdrawn. Cultures of the pleural fluid were negative.
Diagnosis: Infected intralohar bronchopulmonary sequestration
Due to the location of the lesions, the chronic nature of the original mass, and the positive cultures, an infected sequestration was considered. A descending thoracic and upper abdominal aortogram was performed for further evaluation (Fig 3). An anomalous artery arising from the lower thoracic aorta was found to supply the lesions in the right lower lobe. Venous drainage was via pulmonary veins (not shown). Preoperative diagnosis of an intralobar bronchopulmonary sequestration was made. At surgery, the aberrant artery was identified and a right lower lobectomy was performed. Postoperative recovery was uneventful.
Bronchopulmonary sequestration is a congenital mass of dysplastic pulmonary tissue that has no normal connections with the bronchial tree or pulmonary arteries. The isolation of the sequestration from the airway explains the nondiagnostic outcome of bronchoscopy 14 years previously. An aberrant artery arising from the aorta or one of its branches usually perfuses the sequestered lung. Sequestrations are classified as intralobar or extralobar depending on their pleural investments.