Intralobar sequestration of the lung.

This paper reports four cases of a broncho-pulmonary mass, supplied by an aberrant artery, occurring in the lower lobe of the lung. The object in presenting these cases is twofold; to draw attention to the diversity of the radiological picture and to discuss the effect of the systemic aberrant vessel on the production of the condition. Details of 43 cases reported since 1948, relevant to any association that may exist between the aberrant artery and the lung change, are set out (Table I). Findlay and Maier (1951) reviewed the literature up to 1948 and collected 17 cases of aberrant arteries arising from the thoracic aorta and eight cases from the abdominal aorta. The cases reported by Pryce, Sellors, and Blair (1947) were not included in this total. Bruwer, Clagett, and McDonald (1954) concluded that 79 cases of intralobar sequestration had been described, and it is believed that the condition is a good deal more common than has hitherto been thought (Journal of the American Medical Association, 1954). Since the paper by Pryce and others (1947) the condition has been sought and more readily recognized, and to the dual abnormality the name of intralobar sequestra-tion has been given to separate it from other developmentally similar but anatomically different conditions. The clinical features of the disease are for the most part clear-cut and the need for surgical treatment apparent. The embryology of the condition has been discussed in a number of papers. The radiological features of these four cases were unusual in that the character of the lesion showed frequent changes during the pre-operative period of observation. The details will be described in the case reports. There is no emphasis, in the previously reported cases, on this being a common finding in the condition. Because a solid lesion becomes cystic or a cystic lesion apparently disappears, especially when in the posterior basic segment of the lower lobe, the diagnosis of sequestration seems no less likely if on other criteria this is a possibility. It was proposed in Case 3 to perform an angiocardiogram to demonstrate the aberrant vessel, but the history of the illness and the changes and location of the radiological shadow seemed to point so clearly to the correct diagnosis that the procedure was not carried out. Precise information on the intrapul-monary course of the aberrant artery might have been gained by carrying out angiocardiography. The reason for this variability …