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(Circulation. 2008;117:2403-2406.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pulmonary Artery Sling in an Asymptomatic 15-Year-Old Boy

R. Thomas Collins, II, MD; Paul M. Weinberg, MD; Stanford Ewing, MD; Mark Fogel, MD

From the Divisions of Cardiology (R.T.C., P.M.W., S.E., M.F.), Pathology (P.M.W.), and Radiology (P.M.W., M.F.), Children’s Hospital of Philadelphia, and the University of Pennsylvania School of Medicine (R.T.C., P.M.W., S.E., M.F.), Philadelphia, Pa.

Correspondence to R. Thomas Collins II, MD, The Cardiac Center, 2nd Floor, Main Building, 34th Street and Civic Center Blvd, Philadelphia, PA 19104. E-mail collinsr@email.chop.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 15-year-old boy was evaluated for a 3-month history of sharp pain in the upper left chest. Notable findings on the physical examination included a low-frequency long systolic ejection murmur in the left infraclavicular region. The results of a 15-lead ECG were normal (Figure 1). A complete transthoracic echocardiogram was performed and the result was reported as normal (Figure 2). Because of the unusual character of the murmur, the referring cardiologist sent the patient for cardiac magnetic resonance imaging.

View larger version (71K):   Figure 1. A 15-lead ECG demonstrates normal sinus rhythm with sinus arrhythmia. The intervals and morphologies are normal, with no evidence of atrial or ventricular enlargement.

View larger version (34K):   Figure 2. Parasternal short-axis echocardiogram with color demonstrates the LPA arising from the right and coursing leftward.

A complete cardiac magnetic resonance study was performed that included gadolinium-contrasted images. On axial and 3D reconstruction gadolinium-enhanced images, the left pulmonary artery (LPA) was seen arising from the superior aspect of the right pulmonary artery (RPA) (Figures 3 and 4). The LPA was mildly compressed and coursed posterior to the trachea at the level of the carina. No significant compression of the main stem, right, or left bronchi were present (Figures 5 and 6). Pulmonary blood flow imaging showed mild preferential flow to the right lung, with 69% to the right lung and 31% to the left lung (Figures 7 and 8). Pulmonary arterial velocity mapping demonstrated laminar flow to the RPA (Figure 9) and . . . [Full Text of this Article]

This article has been cited by other articles:

				R. T. Collins II, P. M. Weinberg, E. Goldmuntz, and M. Harris Partial Anomalous Left Pulmonary Artery Circulation, May 5, 2009; 119(17): 2405 - 2407. [Full Text] [PDF]