Aberrant left pulmonary artery
Updates to Article Attributes
An aberrant left pulmonary artery (or pulmonary sling) represents an anatomical variant which may result in symptoms because of compression of local structures, in particular the trachea.
Pathology
It is thought to result from a failure of formation of the 6th aortic arch
The term “sling” is best used when the proximal portion of the anomalous vessel impinges on the right main bronchus and causes air trapping of the entire right lung or the right middle and lower lobes, depending on the site of the compression.
The second type of anomalous left pulmonary artery, which often is fatal, is associated with long-segment tracheal stenosis. This type of tracheal stenosis is due to complete cartilage rings—that is,a rigid “O”-ring trachea without a parsmembranacea.
Associated anomalies
Other anomalies which can be associated with aberrant left pulmonary artery are
- complete tracheal rings
- tracheal stenosis
- single lobed left lung
- bilobed right lung
- absent thyroid isthmus
- imperforated anus
- Hirschprung's disease
- intestinal malrotation
- agenesis of left kidney and ureter
- fusion of third and fourth lumbar vertebrae
- diaphragmatic hernia
- agenesis of gall bladder
Radiographic features
Conventional radiographs obtained in neonates at birth may show foetal fluid retention or air, with a mediastinal shift usually to the left side.
In cases of ring sling complex ,conventional, conventional radiographs usually show an absence of unilateral aeration disturbance; the main bronchi have a very horizontal course horizontal courses (ie, low T-shaped carina) that is detectable on high-kilovoltage filtered radiographs and on CT or MR images.
In most cases, the barium esophagram characteristically shows a mass between the trachea and the esophagus, just above the level of the carina.
Modalities such as ultrafast electron beam or spiral CT and MR imaging depict the vascular anatomy well and obviate angiography.
Treatment and prognosis
RepositioningRepositioning of the artery usually cures this compression, because the underlying tracheobronchial tree is basically normal.
The mortality rate is high in patients with this type of anomalous left pulmonary artery, who require tracheal reconstruction,because the stenosis is primary and not due to the vessel.
The success of reconstructive procedures in the rigid trachea can be studied by using three-dimensional CT techniques, including virtual bronchoscopy.
-</ul><p> </p><h4>Radiographic features</h4><p>Conventional radiographs obtained in neonates at birth may show foetal fluid retention or air, with a mediastinal shift usually to the left side.</p><p>In cases of ring sling complex ,conventional radiographs usually show an absence of unilateral aeration disturbance; the main bronchi have a very horizontal course (ie, low T-shaped carina) that is detectable on high-kilovoltage filtered radiographs and on CT or MR images.</p><p>In most cases, the barium esophagram characteristically shows a mass between the trachea and the esophagus, just above the level of the carina. </p><p>Modalities such as ultrafast electron beam or spiral CT and MR imaging depict the vascular anatomy well and obviate angiography. </p><h4>Treatment and prognosis</h4><p> Repositioning of the artery usually cures this compression, because the underlying tracheobronchial tree is basically normal. </p><p>The mortality rate is high in patients with this type of anomalous left pulmonary artery, who require tracheal reconstruction,because the stenosis is primary and not due to the vessel.</p><p>The success of reconstructive procedures in the rigid trachea can be studied by using three-dimensional CT techniques, including virtual bronchoscopy.</p><h4> </h4>- +</ul><p> </p><h4>Radiographic features</h4><p>Conventional radiographs obtained in neonates at birth may show foetal fluid retention or air, with a mediastinal shift usually to the left side.</p><p>In cases of ring sling complex, conventional radiographs usually show an absence of unilateral aeration disturbance; the main bronchi have horizontal courses (ie, low T-shaped carina) that is detectable on high-kilovoltage filtered radiographs and on CT or MR images.</p><p>In most cases, the barium esophagram characteristically shows a mass between the trachea and the esophagus, just above the level of the carina. </p><p>Modalities such as ultrafast electron beam or spiral CT and MR imaging depict the vascular anatomy well and obviate angiography. </p><h4>Treatment and prognosis</h4><p>Repositioning of the artery usually cures this compression, because the underlying tracheobronchial tree is basically normal. </p><p>The mortality rate is high in patients with this type of anomalous left pulmonary artery, who require tracheal reconstruction,because the stenosis is primary and not due to the vessel.</p><p>The success of reconstructive procedures in the rigid trachea can be studied by using three-dimensional CT techniques, including virtual bronchoscopy.</p>
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