A rare case of crossed pulmonary arteries in an infant - case report

Abstract

Crossed pulmonary arteries are a quite rare form of pulmonary arterial malposition. In this anomaly, the left pulmonary artery originates from the pulmonary trunk to the right and usually above the origin of the right pulmonary artery. Both pulmonary arteries cross each other on their course to each respective lung. We presented a case of a Chinese infant with crossed pulmonary arteries. Physical examination showed a mild cyanosis and continuous machine-like heart murmur in the 2 intercostal space at the left sternal border. An echocardiogram revealed pulmonary hypertension, atrial septal defect, patent ductus arteriosus and ostial stenosis in the inferior left pulmonary vein. Dual-source CT angiography was performed for further evaluation of pulmonary trunk and its branches. Dual-source CT angiography showed origin of left pulmonary artery from the pulmonary trunk in a plane superior to that of the right pulmonary artery. The branch pulmonary arteries then crisscrossed as they coursed to their respective lungs. In summary, we report an infant with crossed pulmonary arteries who was diagnosed during dual-source CT angiography. Three-dimensional reconstruction is useful for visualizing this condition. Knowledge of this rare anomaly will help in the differential diagnosis of pulmonary artery abnormalities.

Evaluation of malposition of the branch pulmonary arteries using cardiovascular computed tomography angiography

“…Our study is the largest series of MBPA imaged by CCTA, which showed a hospital-based prevalence of 0.33 % among 4,546 patients with congenital heart disease and 0.06 % among 23,229 patients receiving either CCTA or contrast-enhanced CT. Our study also found that the classic type was about two times more common than the lesser type. Only 15 % (7/46) of the previously reported patients were lesser type of MBPA [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Our study reports the first experience with diagnosing lesser type MBPA using CCTA, and a higher percentage (33 %, 5/15) of patients were identified as lesser type from our database alone.…”

“…Several diagnostic modalities have been reported to diagnose MBPA, including echocardiography, cardiovascular magnetic resonance imaging (CMR) and catheter cardiovascular angiography [3,[7][8][9][10][11][12][13][14]. Echocardiography is the primary method used to diagnose MBPA with the advantage of clinical availability, noninvasive, nonradiation, and high temporal resolution [3,13,17].…”

“…Since the first report of the classic type by Jue et al, in 1966 [2] and the lesser type by Beck et al, in 1970 [1], MBPA remained a rare congenital anomaly (46 cases in a total with seven cases of lesser type) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]; hence, its prevalence, or the percentage of patients with classic or lesser types, cannot be easily estimated. Our study is the largest series of MBPA imaged by CCTA, which showed a hospital-based prevalence of 0.33 % among 4,546 patients with congenital heart disease and 0.06 % among 23,229 patients receiving either CCTA or contrast-enhanced CT. Our study also found that the classic type was about two times more common than the lesser type.…”

“…Recognition of MBPA is very important because it is often associated with other cardiovascular anomalies [1,[3][4][5][6]. To the best of our knowledge, only 46 cases had been presented to date in the English medical literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. They are predominantly in individual case reports with echocardiography as the main diagnostic imaging modality.…”

Crossed Pulmonary Arteries in a Patient With Persistent Truncus Arteriosus

“…Embryologically, the left arch of the sixth pair contributes to the formation of the main and LPA, and part of the right sixth arch contributes to the formation of the RPA [4]. Although the exact cause of crossed PAs is unknown, it is believed that differential growth patterns in the pulmonary trunk lead to a counterclockwise malrotation of the PAs [4][5][6][7][8].…”