Bilateral intralobar sequestration of the lung with a bridging isthmus: pathologic and radiologic findings.

A 4-year-old boy presented with pneumonia. Computed tomography demonstrated a multicystic mass at the posteromedial bilateral lower lobe segments, which were connected by a bronchus behind the heart. Enhanced computed tomography revealed that an anomalous artery arose from the left gastric artery and inserted into the left sequestrated lung and branched to the right one. The diagnosis of bilateral intralobar sequestration (ILS) with a bridging isthmus was made. After removal of the bilateral ILS, radiologic and pathologic approaches were undertaken to reconstruct the vascular and bronchial architectures. The following observations were made: (1) histologically, the region near the anomalous artery insertion site contained bronchial structures, which looked like an ectopic pulmonary hilus. This bronchial structure was continuously observed in the isthmus and its opening of the right sequestrated lung; (2) radiologically, the shape and course of the bronchi within the ILS indicated a distinct bronchial origin that arose from the pulmonary hilus-like structure, and the anomalous artery that ran along with those bronchi, resembled a pulmonary artery. These features suggested that this bilateral ILS might have originated from an accessory lung tissue.

CT pulmonary angiography and CT venography: factors associated with vessel enhancement.

OBJECTIVE: The objective of our study was to determine factors associated with enhancement on CT pulmonary angiography and CT venography. MATERIALS AND METHODS: Two hundred forty-two cases (83 men and 159 women; mean age, 63 years; age range, 21-92 years) underwent CT pulmonary angiography using a bolus-tracking technique; 189 cases subsequently underwent CT venography 3 minutes after the start of the contrast injection. Two different amounts of nonionic iodine contrast medium were administered: patients weighing > 50 kg who were undergoing both CT pulmonary angiography and CT venography received 450 mg I (group B), whereas all other patients received 300 mg I (group A). The enhancement of vessels was subjectively estimated using a four-point scale, and attenuation values were measured at predetermined levels. Multiple regression analyses were performed with attenuation as the dependent variable and patient age, sex, and weight; amount of contrast medium; scanning delay; and presence of embolism as the independent variables. RESULTS: The scanning delay for CT pulmonary angiography ranged from 10 to 31 seconds (mean, 19 seconds; SD, 3.3). Subjective estimates of enhancement quality on CT venography were significantly better for group B than for group A (p < 0.001). Multiple regression analyses revealed that body weight and age were the only significant and consistent independent variables associated with enhancement of the pulmonary arteries. The amount of contrast medium, body weight, and scanning delay were the independent variables that were consistently associated with enhancement of the deep veins. CONCLUSION: The bolus-tracking technique showed relatively small variations in the scanning delay time. Patient age, body weight, and the amount of contrast medium were the important factors associated with vessel enhancement in combined CT pulmonary angiography and CT venography.

Prenatal diagnosis of hypochondrogenesis using fetal MRI: a case report.

We describe the successful prenatal diagnosis of hypochondrogenesis by MRI. Fetal MR findings were the presence of a conspicuous cartilaginous structure in the basioccipital region, ill-defined ossification of the cervical vertebral bodies, hypoplastic thorax, retarded ossification of the pubic bones, and broad, short long bones. In contrast, fetal US revealed only the presence of short long bones. MRI accurately delineated the axial skeleton in this case and is an effective clinical tool for diagnosing skeletal dysplasias in utero.