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Weekly Chest CasesArchive of Old Cases

Case No : 690 Date 2011-01-17

  • Courtesy of Kwang Nam Jin / SMG-SNU Boramae Medical Center
  • Age/Sex 57 / F
  • Chief ComplaintChest Pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Left pulmonary artery sling
Radiologic Findings
Fig 1. The right lateral chest radiograph shows retrotracheal mass like opacity.
Fig 2. On the CT images, the left pulmonary artery originates from the right pulmonary artery(a), courses anterior to the right bronchial tree(b), and ascends posterior to the trachea and anterior to the esophagus before crossing to the left side to enter the left hilar region(c).
Brief Review
In this rare vascular developmental anomaly, the left pulmonary artery arises from the posterior aspect of the right pulmonary artery and passes between the trachea and esophagus to reach the left hilum. The left pulmonary artery thus forms a sling around the distal trachea and the proximal right main bronchus. Those affected by pulmonary artery sling may be classified generally into two groups: one with a normal bronchial pattern and the other with one or more malformations of the bronchotracheal tree (eg, stenosis of a long segment of the trachea or absence of the pars membranacea) as well as cardiovascular abnormalities. In the latter group, mortality and morbidity are high during infancy. The former group includes very few asymptomatic adults. In asymptomatic cases, a pulmonary artery sling may mimic a mediastinal mass on chest radiographs.
References
1. Eva Castan et al. Congenital and Acquired Pulmonary Artery Anomalies in the Adult: Radiologic Overview. RadioGraphics 2006;26:349-371.
2. Siripornpitak S et al. Pulmonary artery sling: anatomical and functional evaluation by MRI. J Comput Assist Tomogr 1997;21:766-768.
3. Zylak CJ et al. Developmental lung anomalies in the adult: radiologic-pathologic correlation. RadioGraphics 2002;22(spec no):S25-S43.
Keywords
Vascular, Congenital,

No. of Applicants : 121

▶ Correct Answer : 75/121,  62.0%
  • - Department of Diagnostic Radiology, Chonbuk National University Hospital , Korea (South) Eun Jung Choi
  • - Gifu Chuo Hospital , Japan Yo Kaneko
  • - KASTURBA MEDICAL COLLEGE , India NAVEEN KULKARNI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Goa Medical College , India Paresh Desai
  • - second hospital xian jiaotong university , China li ming
  • - Cincinnati Children , United States mantosh rattan
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - HSC , Brazil Diogo Pinheiro
  • - Montreal , Canada D J
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - radiologist, aditya imaging centre , India vivek patel
  • - Okayama University , Japan Akihiro Tada
  • - Severance Hospital , Korea (South) Hyun Gi Kim
  • - Smile Radiologic clinic , Korea (South) Sung-Kyu Choi
  • - Hopital Louis Pradel, Lyon , France Clement Proust
  • - SMC , Korea (South) Jihoon Cha
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - NDMVP Nashik , India Imran Jindani
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - KMC,Manipal , India satish maddukuri
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - University of British Columbia , Canada Amr Ajlan
  • - KHOO TECK PUAT HOSPITAL , Singapore SUMER SHIKHARE
  • - Teleradiology solutions , India harish bhambore
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Assam Medical college , India samudra borah
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - SNUH , Korea (South) Eun LEE
  • - korea univ. hospital, radiology department , Korea (South) choo yung
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - Sahyadri Speciality Hospital, Pune , India Kunal Nadgouda
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Plus Medi radiology , Korea (South) Park Sang Hyun
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Saint Malo , France jean-baptiste Noel
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Shree Diagnostics Nashik , India amol jagdale
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - CHRU lille , France manuel toledano
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Yonsei Severance Hospital , Korea (South) Ah hyun Kim
  • - , Korea (South) 媛•
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - All India Institute of medical sciences , India Justin Moses
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Cairo University , Egypt Mamdouh Eissa
  • - Radiology , Korea (South) YOONAH SONG
  • - IRSA , France jean-luc BIGOT
  • - KUMC ansan , Korea (South) kihwan kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Bupyeong Serim Hospital , Korea (South) Hee Seok Choi
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - IRSA Rochefort , France Viviane Pages
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - Chonnam National University Hospital , Korea (South) Jung Hyun Kim
  • - chest hospital , India k bhaskar
  • - CNUH , Korea (South) Hyedoo Jung
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
▶ Correct Answer as Differential Diagnosis : 1/121,  0.8%
  • - Chonnam national university hospital , Korea (South) seo yeon Park
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