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Intralobar bronchopulmonary sequestration: evidence of air trapping shown by dynamic xenon-133 SPECT

Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan

View larger version (164K): [in a new window]   Figure 1. High resolution CT images showing an anomalous left posterior basal segmental bronchus (white arrow) and large, anomalous arteries arising from the descending thoracic aorta (). Focal low attenuation areas surround the anomalous bronchus (arrows) and there are increased vascular markings especially in the peripheral portion of the left lower lobe (arrowheads).

View larger version (105K): [in a new window]   Figure 2. The equilibrium phase of xenon-133 at the same lower lung level as in Figure 1 shows that xenon-133 gas is normally distributed throughout the left lower lobe, except for the lack of activity corresponding to the large, anomalous vessels.

View larger version (17K): [in a new window]   Figure 3. The series of xenon-133 washout phase SPECT images shows significant xenon-133 retention in the lung surrounding the anomalous bronchus and in the peripheral lung of the remaining left lobe, with increased vascular marking (arrows). EQ, equilibrium; WO, washout.

View larger version (113K): [in a new window]   Figure 4. The perfusion SPECT image shows normal pulmonary arterial perfusion only in the left anterior basal segment inferior lobe at this lung level. S5=inferior lingular segment; S8=anterior basal segment inferior lobe.

View larger version (88K): [in a new window]   Figure 5. Angiography of the anomalous arteries and pulmonary artery. (a) The arterial phase of selective angiography of the anomalous arteries (arrow) shows that the lateral and posterior basal segment inferior lobes are supplied by the aberrant arteries bifurcating from the descending thoracic aorta. (b) The venous phase shows that the perfusion of the left lower lobe is partly drained from the pulmonary vein into the left atrium and partly from the azygos vein (arrows). (c) Pulmonary angiogram shows that the apical and anterior basal segment inferior lobes are supplied by the pulmonary artery (arrows). A6, apical inferior lobe artery, A8, anterior basal segmental artery.