Congenital Pulmonary 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 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 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.

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.