CONGENITAL ANOMALIES

CONGENITAL ANOMALIES

Common congenital pulmonary anomalies are sequestration, bronchial cyst and agenesis of lung or pulmonary artery.

• These anomalies are most often recognized by serendipity from CXR obtained for other reasons. Patients with these anomalies are most often asymptomatic.
• Attention can be brought to them because of infection or rupture.

Sequestration

• Sequestration should be considered any time a lesion is noted in medial basal segment of lower lobes.
• They can present because of hemoptysis, or with infection or as CXR abnormality.
• Sequestered lung has no connection to bronchial tree or pulmonary artery .
• It is supplied by vessels from Aorta and are drained by systemic venous system.
• Bronchogram, Lung scan, Aortogram, CT Scan are useful in identifying various aspects of the anomaly.
• Aortogram is gold standard for diagnosis but CT chest in some cases can confirm the diagnosis.

Bronchial Cyst

• Bronchial Cyst can present as a mass in mediastinum or over lung fields.
• Most often they are asymptomatic.
• Occasionally they get infected or can rupture presenting as Pneumothorax.
• CT chest demonstrates cystic nature of the lesion and its close association to bronchial tree thus confirming the diagnosis.
• Surgical resection is necessary only if they are infected , the diagnosis is in doubt or the cyst has ruptured.

Agenesis of Lung

• Hemithorax and Lung fields are asymmetric and smaller than normal. Normally right Lung should be about 55% and left Lung about 45%. Hemithorax size should be symmetrical.
• Pulmonary artery segment is smaller.
• Lung scan , CT chest and Pulmonary angiograms show various aspects of the anomaly.