Sequestration

In cases of bronchopulmonary sequestration, parts of the pulmonary parenchyma may be found without or with an atypical connection to the tra-cheobronchial tree. Pulmonary sequestration may be classified as either extralobar or intralobar sequestration.

Extralobar sequestration is usually located in the posterior costodiaphragmal recessus and is typically more left sided than right sided. Less frequently it is located in the upper abdomen or the mediastinum. In about 50% of cases, extralobar sequestration is associated with other congenital anomalies. Extralobar sequestration is usually surrounded by a proper layer of pleura. The arterial

Extralobar Sequestration

Fig. 7a, b. A 5 year old boy who presented with an unclear pulsating mass in the left supraclavicular fossa of the lower left neck. On the surface rendered image of the thoracic vessels (Gd-BOPTA, 0.1 mmol/kg) a notable tortuous course of the aortic arch distal to the left common carotid artery is apparent (a, arrow). The corresponding dorsal oblique view demonstrates that the left subclavian artery originates from a tortuous part of the aortic arch (b, arrow). These findings are indicative of a pseudocoarctation of the aortic arch blood supply usually derives from the thoracic or abdominal aorta through small branches (Fig. 8) while venous blood drains into the azygous or hemiazygous vein [20].

Intralobar sequestration is usually surrounded by normal pulmonary parenchyma and is located within the normal pleural space. These lesions may be found incidentally in children with no further congenital anomalies. Arterial blood may derive from the pulmonary arteries or aortic branches while venous drainage is usually into the pulmonary veins [21].

Most pulmonary sequestrations are found incidentally on x-ray chest films and therefore require further diagnostic imaging. These anomalies are usually hyperintense on T2w MR imaging while on CE-MRA the anatomic localisation and arterial and venous blood vessel architecture may be suggestive of pulmonary sequestration.

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