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(Circulation. 1997;96:2079.)
© 1997 American Heart Association, Inc.

Articles

Combined Pulmonary Artery Angiography and Tracheobronchography in Pulmonary Artery Sling

Joachim Freihorst, MD; ; Thomas Paul, MD

From the Departments of Pediatric Pulmonology (J.F.) and Pediatric Cardiology (T.P.), Children's Hospital, Hannover Medical School, Germany.

Correspondence to Joachim Freihorst, MD, Department of Pediatric Pulmonology, Hannover Medical School, D-30623 Hannover, FR Germany.

	Introduction

 
A 12-month-old child was evaluated for inspiratory and expiratory stridor present since early infancy. The chest radiograph was normal; on a barium swallow, an anterior impression of the esophagus was evident. Two-dimensional echocardiography did not show any intracardiac abnormality; the origin of the left pulmonary artery, however, could not be visualized.

Combined pulmonary artery angiography and tracheobronchography revealed pulmonary artery sling, with the left pulmonary artery (arrow) arising from the proximal right pulmonary artery and proceeding to the left hilum between trachea and esophagus (Fig 1). The lower trachea was deviated to the left. On tracheobronchoscopy, the distal part of the trachea appeared flattened, with the dorsal wall pulsating synchronously with the cardiac cycle (Fig 2). There was no evidence of tracheal hypoplasia or ring cartilage formation.

View larger version (135K): [in this window] [in a new window]   Figure 1. Visualization of pulmonary artery sling (arrow) clasping trachea after combined contrast injection into pulmonary artery and (via a rigid bronchoscope) lower trachea.

View larger version (141K): [in this window] [in a new window]   Figure 2. Bronchoscopic view of distal part of trachea (a indicates anterior) showing tracheal stenosis with dorsoventral flattening directly above bifurcation. Inner diameter of bronchoscope is 5 mm.

Up to now, the patient is doing well on physical therapy and close clinical follow-up.

In patients with stridor and anterior compression of the esophagus, combined cardiological and pulmonological evaluation is mandatory to demonstrate the origin and size of the left pulmonary artery and to assess the severity of associated malformations of the tracheobronchial tree.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, . . . [Full Text of this Article]