Pulmonary sequestration (prenatal and postnatal ultrasound)

Case contributed by Maulik S Patel

Presentation

Antenatal ultrasound for anomaly scan. No complaints.

An echogenic lesion is noted in left lower hemithorax posteriorly. Its base is noted abutting spine. The lesion also abuts the lower thoracic aorta, part of esophagus and heart. The lesion is posterior and close to normal-appearing stomach bubble. No defect is noted in adjacent spine. The lesion appears to extend in the upper abdomen posterior to stomach. There seems to be a defect in the left hemidiaphragm. Lesion receives arterial supply from the aorta. One or probably two arterial are seen supplying the lesion. It is measuring Cranio-caudal - 15 mm, Axial - 10 mm and Antero-posterior - 10 mm.

No cystic spaces are noted in the lesion. No hydrothorax is noted. No mass effect is noted on heart or stomach bubble.

The right hemidiaphragm is normal. The right lung and rest of the left lung are normal.

Mild fullness of left renal pelvis is noted. No other abnormality could be localized in fetus.

Baby boy. Post natal Day 1 - ultrasound.

ultrasound

An echogenic lesion is noted posterior to gastro-esophageal junction. It also extends to lower left hemithorax. Lesion abuts the upper abdominal aorta. The lesion is posterior to heart. The lesion is echogenic without cystic changes. Lesion receives arterial supply from aorta. One artery is seen supplying the lesion. Discontinuity is noted in left hemidiaphragm. Left adrenal gland is normal.

No pleural effusion is noted in either of pleural cavities.

Hydronephrosis without parenchymal loss is noted in the left kidney with a distended bladder. No hydroureter is noted.

No other abnormality could be localized in the abdomen.

Case Discussion

Other differentials for an echogenic lung lesion in antenatal ultrasound include CCAM (congenital cystic adenomatoid malformation), lobar emphysema, bronchial atresia; all supplied by pulmonary artery.

Antenatal and postnatal findings of lower chest echogenic mass with extension below diaphragm along with blood supply from aorta favors the diagnosis of pulmonary sequestration.

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