Endovascular Embolization of Intrapulmonary Sequestration

J INVASIVE CARDIOL 2020;32(10):E264. 

Key words: computed tomography, pneumonitis, sequestrated lung

A 25-year old woman presented with recurrent chest infections since childhood. She had been experiencing increased frequency of infections and hemoptysis for 1 year and had received multiple courses of antibiotics. Physical examination revealed mild pallor. Routine blood investigations revealed a hemoglobin of 7.8 g/dL with normal kidney and liver function tests. A chest x-ray revealed heterogeneous left lower-lobe opacity (Figure 1A). Computed tomography (CT) scan of the chest revealed irregular subsegmental pneumonitis in the posterior basal segment of the left lower zone, with sequestrated lung lobe along with anomalous vessel arising from the left lateral wall of the descending thoracic aorta (Figure 2). An aortogram with selective dye injection identified the feeder vessel (Video 1).

An informed decision was made for percutaneous closure of the feeder vessel using an Amplatzer vascular plug (St. Jude Medical). The feeder was occluded and was seen to be thrombosed on cine angio scans (Video 2). The patient’s postoperative course involved chest pain on day 2, which was managed with opiates. However, she remained hemodynamically stable throughout. A chest CT on day 7 revealed total occlusion of the feeder artery and resolution of the sequestration (Figure 3).

Traditionally, management of lung sequestrations has been surgical. This is one of the few reports where a percutaneous management has resulted in resolution of symptoms and disease entity, and offers a novel approach for management.

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From the Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 7, 2020.

Address for correspondence: Rakesh Agarwal, MBBS, MD, DM, IPGME&R and SSKM Hospital, AJC Bose Road, P.S-Bhowanipur, Kolkata-700020, India. Email: dr.agarwal.rakesh@hotmail.com