Pulmonary sequestration in children and adults: computed tomography findings

Le résumé fourni par la source

Pulmonary sequestration is a rare congenital lung malformation characterized by a dysplastic segment of pulmonary parenchyma that lacks normal connection to the tracheobronchial tree and receives blood supply from aberrant systemic arteries—most commonly from the aorta and its branches. Two types of sequestration are distinguished based on the location of the abnormal lung tissue relative to the visceral pleura: intralobar and extralobar sequestration. Clinical presentation ranges from asymptomatic incidental imaging findings to symptomatic cases with varying degrees of respiratory or infectious manifestations depending on lesion size and location. Surgical approach depends on sequestration type, making accurate preoperative diagnosis essential. Currently, contrast enhanced computed tomography (CT) is highly informative for evaluating parenchymal changes in the abnormal lung segment, as well as vascular anatomy. This article briefly reviews the etiology and clinical features of pulmonary sequestration and illustrates CT parenchymal and vascular signs that help diagnose and differentiate sequestration types. CT parenchymal findings are highly variable, depending not only on sequestration type but also on the duration of recurrent inflammation in the abnormal segment and the presence of associated congenital airway malformations. The CT semiotics of parenchymal changes in this condition have not been systematized in the literature; different authors provide different descriptive features, focusing on individual signs. The key diagnostic sign of pulmonary sequestration is an aberrant artery arising from the systemic circulation (either from the systemic or pulmonary circuit). Venous drainage and the characterization of sequestration boundaries are important imaging features for differentiating sequestration types (intralobar vs. extralobar). However, diagnosis is complicated by sequestra with mixed venous drainage into both the pulmonary and systemic circuits, which does not always allow assignment to a specific type.

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