Excerpt

Anomalous systemic arterial supply to the lung without sequestration, usually to the left lower lobe [2], is the rarest form of congenital pulmonary systemic arterialization [1]. These fistulae mostly arise from the descending aorta [4], particularly the thoracic portion [3]. Venous drainage is normally through the pulmonary veins. In children, this condition is usually asymptomatic [1] but may present with cardiac failure due to the left-to-left shunt [5]. Cardiac murmurs, recurrent pulmonary infections, and hemoptysis are possible clinical presentations, with the latter resulting from localised pulmonary hypertension. Surgical management, even in asymptomatic patients, is advocated particularly due to its hemorrhagic complications. However, in patients without sequestration and dual arterial supply, percutaneous embolization is a viable option [1]. …