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.
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.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
- Copyright © 1997 by American Heart Association