Abstract: Objective To compare and analyze the clinical and multi-slice spiral CT (MSCT) enhancement findings of anomalous systemic artery to normal lower lobe (ASANLL) and pulmonary sequestration (PS) in order to reduce misdiagnosis rates.Methods We retrospectively collected data from 10 ASANLL patients and 35 PS patients diagnosed at Xuzhou Central Hospital. We analyzed the clinical and MSCT findings of the two diseases, including lesion location, characteristics of anomalous arterial supply in terms of course, diameter, venous return, relationship with bronchi, and surrounding lung parenchymal changes.Results The clinical manifestation of ASANLL patients was hemoptysis (3/10) or asymptomatic (5/10), while PS patients primarily presented with cough and expectoration (19/35). The mean diameter of the arterial supply in ASANLL was (7.790±2.207) mm, whereas in PS, it was (5.683±2.759) mm, showing a statistically significant difference (P<0.05). All 35 PS patients had lung parenchymal lesions with diverse manifestations, whereas ASANLL mostly showed ground-glass opacity in the lungs (6/10), which was statistically significant (P<0.05). There was a statistically significant difference in the incidence of lesions and bronchial communication between the two groups (P<0.05).Conclusions MSCT imaging can effectively display the origin, morphology, and course of aberrant arterial supply, accurately distinguishing between ASANLL and PS, providing objective and powerful evidence for clinical treatment.