Nagase Yuki, Mochizuki Yoshirou, Nakahara Yasuharu, Kawamura Tetsuji, Sasaki Shin, Tsukamoto Hiroaki
Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center.
Nihon Kokyuki Gakkai Zasshi. 2010 Jan;48(1):39-44.
We encountered two cases of systemic arterial supply to the basal segments of bilateral lung with elevated serum CEA levels. The patients were a 36-year-old man and a 30-year-old man with the abnormal chest shadows, discovered during physical checkups. A chest computed tomogram (CT) of the 36-year-old patient showed reticulonodular shadows in the bilateral lower lobe with anomalous vessels arising from the descending aorta and running into the lower lobe on each side, and his abdominal CT revealed a duplicated vena cava inferior. His aortogram confirmed an anomalous systemic arterial supply to the basal segments of bilateral lungs. The chest CT of the 30-year-old patient revealed a cystic lesion in the right lower lobe and no abnormality in the left lung field. His aortograms showed aberrant systemic arterial supplies to the bilateral lower lobe. Because the cystic lesion had increased in size, it was resected and an anomalous systemic artery was seen. Intralobar sequestration in the right lung and anomalous systemic arterial supply in the left lung was diagnosed. Serum CEA was high at the initial visit in each patient but it decreased spontaneously in the first patient, and after the resection of the cystic lesion in the second patient. We report two cases of anomalous systemic arterial supply to the basal segments of bilateral lung, which is extremely rare. Our literature search revealed that only 13 cases have been reported to date.
我们遇到两例双侧肺基底段有体循环动脉供血且血清癌胚抗原(CEA)水平升高的病例。患者为一名36岁男性和一名30岁男性,他们在体检时发现胸部有异常阴影。36岁患者的胸部计算机断层扫描(CT)显示双侧下叶有网状结节阴影,降主动脉发出异常血管并分别进入两侧下叶,其腹部CT显示下腔静脉重复畸形。他的主动脉造影证实双侧肺基底段有异常的体循环动脉供血。30岁患者的胸部CT显示右下叶有一个囊性病变,左肺野无异常。他的主动脉造影显示双侧下叶有异常的体循环动脉供血。由于囊性病变增大,对其进行了切除,术中可见一条异常的体循环动脉。诊断为右肺叶内型隔离症和左肺异常体循环动脉供血。两名患者初诊时血清CEA均升高,但第一名患者血清CEA自发下降,第二名患者在切除囊性病变后血清CEA下降。我们报告两例双侧肺基底段异常体循环动脉供血的病例,这种情况极为罕见。我们的文献检索显示,迄今为止仅报道过13例。