Left pulmonary artery sling: Diagnosis and delineation of associated tracheobronchial anomalies with MR

Abstract

MR is capable of differentiating the two subtypes of SLPA. Specific delineation of vascular and airway anatomy and spatial relationships is essential for surgical management: reimplantation of LPA in type I and both LPA reimplantation and airway reconstruction in type II because of associated long segment airway stenosis.

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

“…The second type of anomalous left pulmonary artery, which often is fatal, is associated with long-segment tracheal stenosis (Fig 7d-7f) (11)(12)(13)(14). (Reference 11 is a classic contribution from Martin H. Wittenborg, MD, Dr Neuhauser's colleague at Children's Hospital Boston in the 1950s and early 1960s.)…”

MDCT and 3D Evaluation of Type 2 Hypoplastic Pulmonary Artery Sling Associated With Right Lung Agenesis, Hypoplastic Aortic Arch, and Long Segment Tracheal Stenosis

“…Hence, MRI has been widely used in evaluating mediastinal vascular anomalies in neonates and pediatric patients. 2,8 However, with the development and widespread availability of MDCT in recent years, MDCT has assumed a greater role in evaluating pediatric mediastinal vascular anomalies. 10,11 MDCT allows isotropic, high-resolution images, faster scan times, and high quality 3D images of the mediastinal vessels and central airways.…”

“…[1][2][3][4][5] When an anomalous left pulmonary artery courses from the right hilum to the left hilum, it passes between the trachea and esophagus resulting in a ''sling'' around the trachea. Multiple congenital anomalies associated with pulmonary artery sling have been reported.…”

“…Type 2 pulmonary artery sling is characterized by low location of the sling, congenital long segment tracheal stenosis, and a horizontal course of the main bronchi (ie, T-shaped carina). 1,2 The early diagnosis and management of pulmonary artery sling associated with central airway compression and/or anomalies is particularly important, because these patients often present with severe respiratory distress such as stridor and hypoxia.…”

“…[1][2][3][4] The early diagnosis and complete anatomic evaluation of pulmonary artery sling is paramount for proper patient management, because patients with this disorder frequently have other congenital anomalies resulting in high morbidity and mortality. [1][2][3][4][5] Until recently, pulmonary artery sling in a neonate has been established with radiologic imaging studies such as plain radiographs, barium swallow studies, fluoroscopy-guided airway studies, and echocardiogram. However, since the development and widespread availability of multidetector computed tomography (MDCT), pulmonary artery sling is increasingly evaluated with this new imaging technology.…”