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CT assessment of tracheobronchial anomaly in left pulmonary artery sling

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Abstract

Background

The left pulmonary artery sling (LPAS) is a rare vascular anomaly where the left pulmonary artery arises from the right pulmonary artery, passes over the right bronchus, and goes posteriorly between the trachea and esophagus. The LPAS is frequently associated with cardiac and non-cardiac defects including tracheobronchial abnormalities.

Objective

To evaluate the utility of multislice CT (MSCT) and helical CT (HCT) in diagnosing and defining the tracheobronchial anomaly and anatomic relationships between the trachea and aberrant left pulmonary artery.

Materials and methods

MSCT or HCT was performed in 27 children to determine the tracheobronchial anatomy and identify tracheobronchial stenosis. Eighteen children underwent surgery.

Results

According to the Wells [6] classification of LPAS, which includes two main types and two subtypes, there were eight cases of type 1A, five cases of type 1B, six cases of type 2A and eight cases of type 2B in this group. Twenty-four of the 27 children had substantial tracheobronchial stenosis. Four died before surgery; the 18 had reanastomosis of the left pulmonary artery. Five children also had tracheoplasty; three died after surgery.

Conclusion

CT, especially MSCT, is an ideal modality for simultaneously identifying aberrant left pulmonary artery and any associated tracheobronchial anomaly. The Wells classification is useful for operative planning.

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Acknowledgment

We thank Mr. Hong Zhang for the schematic drawings.

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Authors and Affiliations

  1. Department of Radiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, China

    Yu-Min M. Zhong, Ming Zhu, Ai-Min M. Sun & Qian Wang

  2. Department of Medical Imaging, Primary Children’s Medical Center, Salt Lake City, UT, USA

    Richard B. Jaffe

  3. Department of Cardiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wei Gao

Authors
  1. Yu-Min M. Zhong
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  2. Richard B. Jaffe
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  3. Ming Zhu
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  4. Wei Gao
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  5. Ai-Min M. Sun
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  6. Qian Wang
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Correspondence to Yu-Min M. Zhong.

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Zhong, YM.M., Jaffe, R.B., Zhu, M. et al. CT assessment of tracheobronchial anomaly in left pulmonary artery sling. Pediatr Radiol 40, 1755–1762 (2010). https://doi.org/10.1007/s00247-010-1682-y

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  • DOI: https://doi.org/10.1007/s00247-010-1682-y

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