MyPACS.net: Radiology Teaching Files > Case 348300

never visited SEQUESTRATION - EXTRALOBAR
Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
Patient: 6 month old male
History: 6 month old with recent RSV infection found to have a posterior mediastinal mass.
Images:[small]larger

Fig. 1: AP chest xray shows left upper lobe opacity with mass effect, as there is mediastinal shift to the right.

Fig. 2: Axial T1 shows large vessel in left upper lobe lesion.

Fig. 3: Coronal T2

Fig. 4: Coronal T1

Fig. 5: Sag T2

Fig. 6: Gadolinium MRA

Fig. 7: Gadolinium MRA

Fig. 8: Axial reformatted image from Gadolinium MRA shows large artery supplying lesion

Fig. 9: Axial reformatted image from gadolinium MRA

Fig. 10: gross photo with ties on vessels

Fig. 11: Large artery leading into ELS

Fig. 12: bronchiole

Fig. 13: CPAM-like areas

Fig. 14: respiratory epithelium with cilia

Fig. 15: intra-alveolar macrophages
Diagnosis: Extrlobar sequestration
Discussion:

Extralobar sequestration is a rare congenital anomaly that consists of pulmonary tissue anatomically separate from normal lung and usually deriving its blood supply from systemic vessels. The lesion typically manifests in the newborn period or early infancy with symptoms of respiratory distress. Less frequently, patients present in childhood or adulthood. Grossly and microscopically, the lesion resembles lung tissue. The typical radiologic finding is a homogeneous soft-tissue mass in the lower hemithorax. However, these lesions can also occur in the mediastinum, within the diaphragm, and, rarely, below the diaphragm. Radiologic diagnosis rests on identification of the systemic vascular supply. Although angiography has been routinely used in the past in evaluating these lesions, other modalities including ultrasound, computed tomography, and magnetic resonance imaging may demonstrate the anomalous feeding and draining vessels. Treatment of extralobar sequestration consists of surgical excision of the mass. Prognosis is usually favorable in the absence of associated congenital anomalies.

References:

ML Rosado-de-Christenson, AA Frazier, JT Stocker, and PA Templeton
From the archives of the AFIP. Extralobar sequestration: radiologic- pathologic correlation.
RadioGraphics 1993; 13: 425-441.
Radiographics / "Radiology Journal"

Dr. Phillip Silberberg,Children's Hospial in Omaha, NE
Dr. Chad Eicher, Radiology Resident, Creighton University Medical Center
Benjamin Silberberg

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Additional Details:

Case Number: 348300Last Updated: 05-02-2005
Anatomy: Lung   Pathology: Benign Mass, Cyst
Modality: Conventional Radiograph, MR, PathologyExam Date: 01-01-1985Access Level: Readable by all users
Keywords: sequestration extralobar

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