C63-50 The Hidden Artery Feeding the Lung in a 59-Year-Old Female

Introduction Pulmonary sequestration is a rare congenital lung malformation characterized by a segment of nonfunctioning lung parenchyma that lacks communication with the tracheobronchial tree and receives its arterial supply from the systemic circulation. It accounts for approximately 0.5 - 0.6% of all congenital pulmonary malformations. Most cases are identified during infancy or childhood; therefore, diagnosis in adulthood is exceedingly uncommon. Case Presentation A 59-year-old female, followed in the pulmonary clinic for obstructive sleep apnea, was incidentally found to have a pulmonary nodule with apparent calcification on chest radiograph (CXR). Chest CT scan reveals an aberrant arterial vessel arising from the anterior aspect of the descending thoracic aorta at T8-T9 that courses posterolaterally toward the left hilum and drains into the left lower hilar pulmonary vein. This vessel measures approximately 12 mm in diameter and shows atheromatous calcification, suggesting chronic vascular changes and supporting the notion that this is a long-standing process. However, the patient has remained asymptomatic, and the physical examination has been unremarkable. Discussion This case provides insight into a rare presentation of atypical arterial supply pattern to the normal lung, with vascular changes suggestive of a long-standing, stable variant. Although typically diagnosed in childhood, congenital anomalies such as sequestration should be considered in adults with unexpected radiographic findings, especially when lesions appear atypical or calcified. Recognition of the characteristic systemic arterial supply and pulmonary venous drainage on imaging is crucial for diagnosis and for preoperative planning if symptoms develop. We highlight that calcified pulmonary nodules on CXR can also be associated with pulmonary malformations, which are less common but must be identified, as patients can develop symptoms and be complicated by recurrent infections or hemoptysis. Therefore, detailed imaging and early identifications allows for appropriate management and better long-term outcomes. This abstract is funded by: none