Anomalous Systemic Arterial Supply to the Basal Segment of the Lung Treated With Surgery Versus Transcatheter Embolisation: A Report of Two Cases.

Anomalous systemic arterial supply to the basal segment of the lungs (ABLL) is a rare congenital vascular anomaly, and its treatment remains disputed. We report two cases of ABLL that were asymptomatic and managed using different strategies based on infection status and anatomical complexity. A 25-year-old woman presented with a right lower lobe cavitary lesion supplied by an anomalous coeliac artery branch. Due to suspected chronic fungal infection, thoracoscopic right basal segmentectomy was performed, and subsequent pathology and cultures confirmed chronic cavitary aspergillosis. A 33-year-old man presented with an anomalous branch from the descending thoracic aorta supplying the left basal segment. Surgical resection was considered potentially more invasive because of an incomplete fissure and a common left pulmonary vein trunk; therefore, transcatheter embolisation was successfully performed. These cases suggest that treatment selection should be individualised and guided not only by vessel diameter but also by associated infection and anatomical complexity.