Figure 1
Chest CT
Pulmonary Artery Sling
SectionChest imaging
Case TypeClinical Cases
AuthorsRepanas G, Papadopoulos M, Anastasiadou K, Galanis S, Tsanaktsidis G, Palladas P.
Connected authors
62 years, female
Clinical History
A 62 year old female underwent a chest CT after a car accident.
Imaging Findings
The patient was involved in a traffic accident and she had no prior medical problems. Chest CT examination-multiplanar imaging reconstruction revealed a vascular abnormality in which the left pulmonary artery arises irregularly from the posterior tract of the normal right pulmonary artery. The anomalous vessel passes through the space between the lower tract of the trachea and the oesophagus and reaches the left lung hilum, without causing compression symptoms to these anatomical structures.
Discussion
Anomalous left pulmonary artery (pulmonary artery sling) is a rare vascular abnormality in which the left pulmonary artery arises irregularly from the posterior tract of the normal right pulmonary artery. The anomalous vessel passes through the space between the lower tract of the trachea and the oesophagus and reaches the left lung hilum, causing frequently compression symptoms to these anatomical structures that may lead to(produce) left displacement of trachea, atelectasis, obstructive emphysema and dysphagia.
This condition is considered the result of the involution of the proximal left sixth arch. Due to this missing development, an anastomotic vessel links the primitive pulmonary circulations and evolves in the aberrant left pulmonary artery.
There has been described a frequent association with other congenital malformations involving mostly the tracheobronchial tree and the cardiovascular system.
Tracheobronchial anomalies include a bronchus that arises directly from the trachea to supply a segment of the right upper lobe, hypoplasia of distal trachea, incomplete cartilaginous tracheal ring and stenosis of left main bronchus. Cardiovascular anomalies consist of atrial septal defect, ventricular septal defect, patent ductus arteriosus, tetralogy di Fallot, aortic stenosis, and persistent left superior vena cava and aortic arch anomalies.
In infants and newborns it usually presents with intermittent cyanosis, dyspnoea, expiratory stridor and wheezing due to the airway obstruction by the abnormal vessel and associated with high mortality especially if not treated. The severity of the symptoms and the prognosis are also related to the eventual association with other congenital abnormalities. On the other hand in adults it may be asymptomatic and discovered accidentally, as described in our case.
This condition is considered the result of the involution of the proximal left sixth arch. Due to this missing development, an anastomotic vessel links the primitive pulmonary circulations and evolves in the aberrant left pulmonary artery.
There has been described a frequent association with other congenital malformations involving mostly the tracheobronchial tree and the cardiovascular system.
Tracheobronchial anomalies include a bronchus that arises directly from the trachea to supply a segment of the right upper lobe, hypoplasia of distal trachea, incomplete cartilaginous tracheal ring and stenosis of left main bronchus. Cardiovascular anomalies consist of atrial septal defect, ventricular septal defect, patent ductus arteriosus, tetralogy di Fallot, aortic stenosis, and persistent left superior vena cava and aortic arch anomalies.
In infants and newborns it usually presents with intermittent cyanosis, dyspnoea, expiratory stridor and wheezing due to the airway obstruction by the abnormal vessel and associated with high mortality especially if not treated. The severity of the symptoms and the prognosis are also related to the eventual association with other congenital abnormalities. On the other hand in adults it may be asymptomatic and discovered accidentally, as described in our case.
Differential Diagnosis List
Anomalous left pulmonary artery (pulmonary artery sling)
Final Diagnosis
Anomalous left pulmonary artery (pulmonary artery sling)
References
[1] Stone DN, Bein ME, Garris JB (1980) Anomalous left pulmonary artery: two new adult cases. AJR Am J Roentgenol 135(6):1259-63. (PMID: 6779536)
[2] Procacci C, Residori E, Bertocco M, Di Benedetto P, Andreis IA, D\'Attoma N (1993) Left pulmonary artery sling in the adult: case report and review of literature. Cardiovasc Intervent Radiol 16:388-391. (PMID: 8131173)
Case information
| URL: | https://www.eurorad.org/case/7733 |
| DOI: | 10.1594/EURORAD/CASE.7733 |
| ISSN: | 1563-4086 |
