대한흉부영상의학회 Weekly Chest Cases

Case No : 350 Date 2004-07-10

Courtesy of Yeon Joo Jeong, M.D., Ki Seok Choo, M.D., Kun-Il Kim, M.D. / Pusan National University Hospital, Busan, Korea
Age/Sex 4 / F
Chief ComplaintPrematurity, respiratory difficulty

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary artery sling (subcarinal type) and patent ductus arteriosus
Radiologic Findings: Serial transaxial images (Fig. a-f) of contrast enhanced chest CT scan and three-dimensional volume rendering images (Fig. g-h) show an anomalous and low origin of left pulmonary artery (arrow) arising the right pulmonary artery. This anomalous left pulmonary artery cross the subcarinal area and swing behind the left main bronchus to reach the left hilum. The left main bronchus is narrowed. Also note a dilated and tortous patent ductus arteriosus (arrowhead).
Brief Review: "Pulmonary sling" is the term commonly used to describe an anomalous or aberrant left pulmonary artery (1-3). In the classic form (supracarinal) of pulmonary sling, an anomalous, retrotracheal left pulmonary artery arises from the extrapericardial segment of the right pulmonary artery and wraps around the junction of the trachea and right main stem bronchus to pass in front of the esophagus on its way to the left lung. The anomalous artery may cause compression of the right main stem bronchus. Subcarinal type of pulmonary sling, however, anomalous and low origin of a good sized left pulmonary artery arises from right pulmonary artery and cross the subcarinal area and swing behind the left main bronchus to reach the left hilum.Therefore, it causes left main bronchus obstruction like our case (4).
References: 1. Stone DN, Bein ME, Garris JB. Anomalous left pulmonary artery: two new adult cases. Am J Roentgenol 1980; 135:1259-1263

2. Moncada R, Demos Tc, Churchill R, Reyes C. Case report. Chronic stridor in a child: CT diagnosis of pulmonary vascular sling. J Comput Assist Tomogr 1983; 7:713-715

3. Berdon WE. Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium--the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD.Radiology 2000; 216(3):624-632

4. Fraisse A, Daou L, Bonhoeffer P. An unusual (subcarinal) case of pulmonary artery sling. Heart 2001; 85:457
Keywords: Vascular, Congenital,

No. of Applicants : 25

▶ Correct Answer : 14/25, 56.0%

- Air force education & training command Hospital, Korea Hyukwon Chang
- Annecy Hospital, France Gilles Genin
- Asan Medical Center, Korea Eun Jin Chae
- Busan Veterans Hospital, Korea Suhku Huh
- Dong-A University Hospital, Korea Ki-Nam Lee
- Eulji hospital, Korea Jeong Joo Woo
- GeojeBaek Hospital, Gyungnam, Korea James Lim
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Mubarak Hospital, Kuwait Varghese Sajeev PJ
- National Taiwan University Hospital, Taiwan Tan Che Kim
- Samsung Medical Center, Korea Semin Chong
- Seoul National University Hospital, Korea Heesun Park
- Sharma Clinic, Jaipur, India Dinesh Sharma
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 4/25, 16.0%

- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- CHU Grenoble, France Mathieu Rodiere
- CIM Saint Dizier, France JC Leclerc
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 350 Date 2004-07-10

Discussion

No. of Applicants : 25