Today we are showing PA radiographs of a 55-year-old woman, asymptomatic. The image presented is a reconstruction of a CT examination (no radiograph available). Muppet believes it is worth showing because it is an unusual disease and has teaching value. What do you see?
Check the image below, leave your thoughts in the comments section and come back on Friday for the answer.
Findings: the AP chest reconstruction shows a tubular structure in the right lower lung (A,B arrows), which suggests a blood vessel. The first possibility that comes to mind is a scimitar vein, although there are no signs of pulmonary hypoplasia, a common finding in scimitar syndrome.
CT shows that the abnormal vessel is an artery arising from the descending aorta (C,D arrows). With lung window, no abnormalities are seen in the RLL; calcium is seen in the wall of the artery (E, arrow).
Final diagnosis: isolated systemic supply to normal lung (pseudo sequestration)
Congratulations to Aleksander Marin, who was the first to see the abnormal vessels.
Teaching point: pseudo sequestration is a rare disease and I just wanted to show you a new case, seen a few weeks ago. We published two cases many years ago and an interesting fact is that the abnormal artery is seen most of the time in the plain film.
