Teaching Case

A six-year-old girl followed in Pediatric Cardiology Consultation for patent ductus arteriosus, pulmonary arterial hypertension and arteriovenous fistula. She underwent surgical ligation of the ductus arteriosus and maintains, however, pulmonary arterial hypertension that requires regular observations and where closure of the arteriovenous fistula is planned.

The girl underwent a CT angiogram that revealed a short aneurysmal dilation of the celiac trunk segment (10 mm with diameter of 9.7 mm). In the segment of the dilated celiac artery we observed the origin of splenic artery, common hepatic artery and an abnormal engorged in its middle third (9 mm in diameter), which rises to the chest and irrigates the basal segments of right lower lobe. The pulmonary venous return of these segments is carried out by a right inferior pulmonary vein, which is ectatic.
In conclusion, the lower lobe of right lung receives irrigation by systemic origin (originating from the celiac trunk) and has a venous return to the pulmonary vein, suggesting intralobar type of sequestration, with normal bronchial permeability.

Anatomic variants are incidental findings in celiac trunk examinations of the abdomen in asymptomatic adults. They assume importance, especially in paediatric patients when they cause symptoms or have bearing on planning of surgery like in cirrhotic patients selected for hepatic transplantation.
Systemic arterial supply to the lungs can be congenital or due to acquired disease. Congenital diseases encompass bronchopulmonary sequestration and congenital pulmonary venolobar syndrome, in which the involved lung parenchyma is supplied by aberrant systemic arteries. Hypertrophied systemic arteries include the bronchial arteries, intercostal arteries, internal mammary arteries, inferior phrenic arteries, branches of the thyrocervical trunk, branches of the hepatic arteries, and branches of the abdominal aorta [2].

The correct diagnosis and treatment plan can be determined by identification of the systemic arteries on computed tomographic scans.