Anomalous body artery supplying a normal left lower basal lung segment refers to a very rare congenital anomaly in which an anomalous artery originating from the descending or abdominal aorta supplies a left lower basal lung segment in which both the bronchial tree and lung parenchyma are normal. With the widespread use of multilayer spiral CT, the number of reports on this malformation has gradually increased. However, by searching the literature, it is less reported in China. There was a case in our hospital in May this year, which is reported as follows: to raise awareness of this malformation.
This malformation has been named as “intralobular pulmonary segregation (Pryce type I)”, “anomalous somatic arterialization of the lung without pulmonary segregation”, “vagal artery supplying the left lung”, and “vagal artery supplying the left lower lung”. “somatic artery supplying the basal segment of the normal left lower lung” or “anomalous somatic artery supplying the basal segment of the normal left lower lung”. Considering that the disease usually involves only the basal segment of the left lower lung, in which the somatic artery is an anomalous artery, it seems more accurate to call it “anomalous somatic artery supplying the normal basal segment of the left lower lung”. It is controversial whether the anomalous corpora arteriosa supplying the normal left lower basal lung segment is classified as pulmonary isolation. Some scholars have classified this malformation as a broad form of pulmonary segregation – intralobar pulmonary segregation (Pryce type I); however, more and more scholars have recently concluded that the anomalous body artery supplying the basal segment of the normal left lower lung is distinctly different from true pulmonary segregation: the lung tissue and bronchial tree connections are completely normal in this malformation. I also share this view. Isolation of the lung and anomalous body artery supplying lung tissue are two different malformations that can co-exist. Wu Ke, Department of Thoracic Surgery, Air Force General Hospital
The exact etiology of this disease is unclear, and it is speculated that it may be due to the failure of normal degeneration of the primitive aortic branches supplying the pulmonary germ before the development of the main pulmonary artery. Pathologically, there is no direct traffic between the anomalous corpora arteriosa and the basal segmental veins. The lung parenchyma and bronchial tree are normal, but pulmonary congestion is obvious and may be accompanied by intra-alveolar hemorrhage, and the patient bleeds and coughs up discomfort. The branches of the anomalous corporal artery travel along the bronchus, and there is a significantly thickened elastic layer within its wall, and some of them may have atherosclerosis and calcification, similar to the arteries of the body circulation.
Most of the disease has no clinical symptoms and physical examination has no obvious positive signs, but there may be clinical manifestations such as coughing up blood, heart murmur and congestive heart failure. In this case, it was detected by CT chest examination due to hemoptysis following a cold and cough. The diagnosis of this disease is also dependent on enhanced CT, especially spiral CT enhancement scan and 3D image reconstruction of blood vessels, which can clearly show the whole picture of the anomalous body artery supplying the normal left lower basal lung segment in a single examination, avoiding invasive angiography and fatal puncture biopsy. The disease also needs to be differentiated from pulmonary arteriovenous fistula, pulmonary isolation and lung tumor with bronchial mucus plug.