Pulmonary artery sling: a rare cause of stridor and respiratory distress

A rare duo: Pulmonary arterial sling with a pig bronchus

Pulmonary artery sling is an incomplete vascular ring, where the left pulmonary artery originates from the right pulmonary artery, leading to airway constriction. A tracheal bronchus is an anatomical variation in which an extra bronchus originates from the trachea, frequently resulting in respiratory symptoms or complications. We report a 6-week-old female patient with a pulmonary artery sling coursing around the distal trachea and a concurrent tracheal bronchus.

Pulmonary Artery Sling Associated with Stridor from Early Infancy: A Case Report

Background

Pulmonary artery sling is a rare condition in which the left pulmonary artery anomalously originates from a normally positioned right pulmonary artery. The left pulmonary artery arises anterior to the right main bronchus, courses between the trachea and esophagus then enters the left hilum. Respiratory symptoms such as wheezing, stridor, cough, and dysphasia are common in this anomaly.

Case presentation

We describe a 16-month-old male infant presenting recurrent cough, stridor, and wheezing from early infancy. He underwent computed tomography angiography, bronchoscopy, and transthoracic echocardiography, confirming the left pulmonary artery sling diagnosis. Surgical correction of pulmonary artery sling was successfully performed as a new anastomosis between the main pulmonary artery and the left pulmonary artery, as well as tracheoplasty. The infant was discharged without any complications. Follow-up after two years revealed no respiratory symptoms and feeding difficulty.

Conclusion

In the presence of chronic cough, stridor, recurrent wheezing, and other prolonged respiratory symptoms, investigation for possible detection of pulmonary artery sling is recommended.