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A study of pulmonary ligament arteries. Relationship to intralobar pulmonary sequestration
Insights
Intralobar pulmonary sequestration (ILS) may not be congenital. Systemic arteries found in pulmonary ligaments suggest a developmental pathway involving bronchial obstruction and parasitic vascularization, challenging traditional views of ILS etiology.
Area of Science:
- Pediatric Thoracic Surgery
- Congenital Lung Malformations
- Vascular Anatomy
Background:
- Intralobar pulmonary sequestration (ILS) is typically viewed as a congenital anomaly.
- Its etiology is often linked to the presence of systemic arterial supply to the sequestered lung segment.
- The origin and development of these systemic arteries have remained incompletely understood.
Purpose of the Study:
- To investigate the presence and origin of systemic arteries within the pulmonary ligaments in children.
- To propose a novel hypothesis for the development of intralobar pulmonary sequestration.
- To challenge the exclusively congenital origin theory of ILS.
Main Methods:
- Anatomical study of pulmonary ligaments in children without congenital pulmonary or vascular disease.
- Detailed examination of arterial supply to the pulmonary ligament and visceral pleura.
- Correlation of findings with a proposed sequence of pathological events.
Main Results:
- Systemic arteries were identified in the pulmonary ligaments of 10 out of 11 children.
- These arteries originated from the thoracic aorta and supplied the visceral pleura.
- Multiple arteries (up to five) were observed in a single case.
Conclusions:
- The frequent presence of systemic arteries in pulmonary ligaments suggests a potential acquired origin for ILS.
- A proposed pathway involves bronchial obstruction, pneumonia, pleuritis, and parasitic vascularization of ligamentous arteries.
- This challenges the long-held belief that intralobar pulmonary sequestration is solely a congenital malformation.
Abstract:
Intralobar pulmonary sequestration (ILS) has generally been considered a congenital malformation, mainly because of the presence of one or more systemic arteries to the sequestered portion of lung. We performed a study of the pulmonary ligaments in children without congenital pulmonary or vascular disease that demonstrated systemic arteries in ten of 11 cases, with as many as five arteries present in a single case. These arteries arose from the thoracic aorta, contributed to the esophageal plexus, and traversed the pulmonary ligament to ramify in the visceral pleura. A sequence of events including bronchial obstruction, pneumonia, pulmonary artery occlusion, pleuritis, and parasitization of pulmonary ligament (or diaphragmatic) arteries leading to the "creation" of an ILS is proposed.