PMC9136689_01
Initial imaging tests. (A) Parenchymal opacity on Chest X-ray (arrowhead); (B) and (C) Origin of aberrant aneurysmal artery with calcified wall and mural thrombus supplying abnormal pulmonary parenchyma on CTA (black arrows).
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Chest X-ray showed a parenchymal opacity at the base of the right hemithorax (Figure 1A), suggestive of acute pneumopathy or intra-alveolar hemorrhage. The feeding artery measured 9 mm at its origin in the abdomen (Figure 1B) and followed a transverse and ascending course toward the abnormal pulmonary parenchyma in the right basal lobe. It became aneurysmal (33 x 32 x 74 mm), with mural calcifications, atherosclerotic changes, and partial thrombosis (Figure 1C).
(A) Aberrant aneurysmal artery of PS on lateral angiography (arrowhead); (B) Selective angiogram showing the tortuous course of the aberrant artery (black arrow) terminating in the sequestration parenchyma (stars). *At this time, the contrast passed into the airway inducing cough.
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Multiplanar aortography (Figure 2A) was performed through a 7 Fr Raabe  right femoral access (Cook Medical, Bloomington, IN, United States) under local anesthesia and endovascular treatment was performed after selective catheterization of the sequestration artery (Figure 2B). A selective angiography with a 5Fr glide catheter showed passage of contrast into the airway and induced cough (Figure 2B).
Post-embolization aortography shows the absence of flow after deployment of the Amplatzer II plug and coils along the aberrant aneurysmal artery.
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Amplatzer Vascular Plug II  (AGA Medical, Plymouth, MN) was deployed in the proximal third of the sequestration artery. Angiography confirmed correct deployment, with no protrusion into the aorta and absence of flow in the sequestration artery (Figure 3).
CTA performed before hospital discharge shows (A) the Amplatzer plug (arrowhead) and (B) the coils (black arrow), with absence of contrast and thrombus formation in the aneurysmal sac (black arrow in 4B).
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Control CTA performed before hospital discharge confirmed complete thrombosis of the aberrant aneurysmal artery and absence of irrigation within the PS, without pleural effusion or signs of hemorrhage (Figure 4).
The figure shows a CTA performed at admission, before endovascular treatment (A) soft tissue window and (B) lung window; and a follow-up CTA performed 56 months after the intervention (C) soft tissue window and (D) lung window. A significant decrease in pulmonary sequestration size is observed, from 77 x 40 mm in 2016 to 28 x 18 mm in 2021 (white arrows in A and C).
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CTA at 1, 6, 16, and 56 months showed complete thrombosis of the aberrant artery and involution of the PS, with a reduction of 49 mm in its largest diameter (Figure 5).