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Pediatrics
Diagnosis
Airway
Extrinsic Vascular Compression of Airway
Pulmonary Sling
Pulmonary Sling
Randy R. Richardson, MD; Mantosh S. Rattan, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Pulmonary artery sling (PAS)

          • Synonyms

            • Aberrant left pulmonary artery (LPA), LPA sling

          • Definitions

            • LPA originates from proximal right pulmonary artery (RPA) & wraps around right & posterior walls of distal trachea (forming sling) as it passes leftward between trachea & esophagus

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • CT Findings

                  • MR Findings

                    • Echocardiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Hong X et al: Tracheal development after left pulmonary artery reimplantation: an individual study. Sci Rep. 10(1):17702, 2020
                                      2. Maldjian PD et al: Partial anomalous left pulmonary artery sling in an adult. J Clin Imaging Sci. 10:5, 2020
                                      3. Porcedda G et al: Combined surgical and endoscopic approach for ring-sling complex. Thorac Cardiovasc Surg. 68(1):51-8, 2020
                                      4. Vu HV et al: Surgical reconstruction for congenital tracheal malformation and pulmonary artery sling. J Cardiothorac Surg. 14(1):49, 2019
                                      5. Arcieri L et al: Impact of 3D printing on the surgical management of tracheal stenosis associated to pulmonary sling: a case report. J Thorac Dis. 10(2):E130-3, 2018
                                      6. Farkas A et al: Arterial tortuosity syndrome: an extremely rare disease presenting as a mimic of pulmonary sling. Radiol Case Rep. 13(1):295-8, 2018
                                      7. Li X et al: Prenatal diagnosis of anomalous origin of pulmonary artery. Prenat Diagn. 38(5):310-7, 2018
                                      8. Shi K et al: Dual-source computed tomography for quantitative assessment of tracheobronchial anomaly from type IIA pulmonary artery sling in pediatric patients. Eur J Radiol. 102:30-5, 2018
                                      9. Yao M et al: Clinical and imaging features of pulmonary artery sling: the experience in one major medical center. Echocardiography. 35(8):1237-42, 2018
                                      10. Fukuda H et al: 3-dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female. Exp Ther Med. 14(3):2600-2, 2017
                                      11. Ochiai D et al: Prenatal sonographic images of left pulmonary artery sling. Eur J Obstet Gynecol Reprod Biol. 211:217-8, 2017
                                      12. Backer CL et al: Vascular rings. Semin Pediatr Surg. 25(3):165-75, 2016
                                      13. Javia L et al: Rings, slings, and other tracheal disorders in the neonate. Semin Fetal Neonatal Med. 21(4):277-84, 2016
                                      14. Chowdhury MM et al: Imaging of congenital lung malformations. Semin Pediatr Surg. 24(4):168-75, 2015
                                      15. Hsieh ML et al: Single origin of right and left pulmonary arteries from ascending aorta with atretic main pulmonary artery from right ventricle and left pulmonary sling. J Cardiovasc Comput Tomogr. 9(6):599-600, 2015
                                      16. Leonardi B et al: Imaging modalities in children with vascular ring and pulmonary artery sling. Pediatr Pulmonol. 50(8):781-8, 2015
                                      17. Smith BM et al: Rings and slings revisited. Magn Reson Imaging Clin N Am. 23(1):127-35, 2015
                                      18. Gundavaram MS et al: Asymptomatic pulmonary artery sling: a rare congenital vascular anomaly. Heart Lung Circ. 22(4):297-9, 2013
                                      19. Backer CL et al: Pulmonary artery sling: current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 143(1):144-51, 2012
                                      20. Berdon WE et al: The triad of bridging bronchus malformation associated with left pulmonary artery sling and narrowing of the airway: the legacy of Wells and Landing. Pediatr Radiol. 42(2):215-9, 2012
                                      21. Kir M et al: Vascular rings: presentation, imaging strategies, treatment, and outcome. Pediatr Cardiol. 33(4):607-17, 2012
                                      22. McDonald ES et al: A rare case of horseshoe lung presenting in adulthood and associated with a pulmonary sling: case report and review of the literature. J Thorac Imaging. 25(3):W97-9, 2010
                                      23. Newman B et al: Left pulmonary artery sling--anatomy and imaging. Semin Ultrasound CT MR. 31(2):158-70, 2010
                                      24. Backer CL et al: Tracheal reconstruction in children with unilateral lung agenesis or severe hypoplasia. Ann Thorac Surg. 88(2):624-30; discussion 630-1, 2009
                                      25. Baden W et al: Comparison of imaging techniques in the diagnosis of bridging bronchus. Eur Respir J. 31(5):1125-31, 2008
                                      26. Yu JM et al: The prevalence and clinical impact of pulmonary artery sling on school-aged children: a large-scale screening study. Pediatr Pulmonol. 43(7):656-61, 2008
                                      27. Lee KH et al: Use of imaging for assessing anatomical relationships of tracheobronchial anomalies associated with left pulmonary artery sling. Pediatr Radiol. 31(4):269-78, 2001
                                      28. Woods RK et al: Vascular anomalies and tracheoesophageal compression: a single institution's 25-year experience. Ann Thorac Surg. 72(2):434-8; discussion 438-9, 2001
                                      29. Berdon WE: 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. Radiology. 216(3):624-32, 2000
                                      30. Donnelly LF et al: The spectrum of extrinsic lower airway compression in children: MR imaging. AJR Am J Roentgenol. 168(1):59-62, 1997
                                      31. Siripornpitak S et al: Pulmonary artery sling: anatomical and functional evaluation by MRI. J Comput Assist Tomogr. 21(5):766-8, 1997
                                      32. Newman B et al: Left pulmonary artery sling: diagnosis and delineation of associated tracheobronchial anomalies with MR. Pediatr Radiol. 26(9):661-8, 1996
                                      33. Katz M et al: Spiral CT and 3D image reconstruction of vascular rings and associated tracheobronchial anomalies. J Comput Assist Tomogr. 19(4):564-8, 1995
                                      34. Berdon WE et al: Vascular anomalies and the infant lung: rings, slings, and other things. Semin Roentgenol. 7(1):39-64, 1972
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Pulmonary artery sling (PAS)

                                              • Synonyms

                                                • Aberrant left pulmonary artery (LPA), LPA sling

                                              • Definitions

                                                • LPA originates from proximal right pulmonary artery (RPA) & wraps around right & posterior walls of distal trachea (forming sling) as it passes leftward between trachea & esophagus

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • Fluoroscopic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Echocardiographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Hong X et al: Tracheal development after left pulmonary artery reimplantation: an individual study. Sci Rep. 10(1):17702, 2020
                                                                          2. Maldjian PD et al: Partial anomalous left pulmonary artery sling in an adult. J Clin Imaging Sci. 10:5, 2020
                                                                          3. Porcedda G et al: Combined surgical and endoscopic approach for ring-sling complex. Thorac Cardiovasc Surg. 68(1):51-8, 2020
                                                                          4. Vu HV et al: Surgical reconstruction for congenital tracheal malformation and pulmonary artery sling. J Cardiothorac Surg. 14(1):49, 2019
                                                                          5. Arcieri L et al: Impact of 3D printing on the surgical management of tracheal stenosis associated to pulmonary sling: a case report. J Thorac Dis. 10(2):E130-3, 2018
                                                                          6. Farkas A et al: Arterial tortuosity syndrome: an extremely rare disease presenting as a mimic of pulmonary sling. Radiol Case Rep. 13(1):295-8, 2018
                                                                          7. Li X et al: Prenatal diagnosis of anomalous origin of pulmonary artery. Prenat Diagn. 38(5):310-7, 2018
                                                                          8. Shi K et al: Dual-source computed tomography for quantitative assessment of tracheobronchial anomaly from type IIA pulmonary artery sling in pediatric patients. Eur J Radiol. 102:30-5, 2018
                                                                          9. Yao M et al: Clinical and imaging features of pulmonary artery sling: the experience in one major medical center. Echocardiography. 35(8):1237-42, 2018
                                                                          10. Fukuda H et al: 3-dimensional computed tomography imaging of the ring-sling complex with non-operative survival case in a 10-year-old female. Exp Ther Med. 14(3):2600-2, 2017
                                                                          11. Ochiai D et al: Prenatal sonographic images of left pulmonary artery sling. Eur J Obstet Gynecol Reprod Biol. 211:217-8, 2017
                                                                          12. Backer CL et al: Vascular rings. Semin Pediatr Surg. 25(3):165-75, 2016
                                                                          13. Javia L et al: Rings, slings, and other tracheal disorders in the neonate. Semin Fetal Neonatal Med. 21(4):277-84, 2016
                                                                          14. Chowdhury MM et al: Imaging of congenital lung malformations. Semin Pediatr Surg. 24(4):168-75, 2015
                                                                          15. Hsieh ML et al: Single origin of right and left pulmonary arteries from ascending aorta with atretic main pulmonary artery from right ventricle and left pulmonary sling. J Cardiovasc Comput Tomogr. 9(6):599-600, 2015
                                                                          16. Leonardi B et al: Imaging modalities in children with vascular ring and pulmonary artery sling. Pediatr Pulmonol. 50(8):781-8, 2015
                                                                          17. Smith BM et al: Rings and slings revisited. Magn Reson Imaging Clin N Am. 23(1):127-35, 2015
                                                                          18. Gundavaram MS et al: Asymptomatic pulmonary artery sling: a rare congenital vascular anomaly. Heart Lung Circ. 22(4):297-9, 2013
                                                                          19. Backer CL et al: Pulmonary artery sling: current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 143(1):144-51, 2012
                                                                          20. Berdon WE et al: The triad of bridging bronchus malformation associated with left pulmonary artery sling and narrowing of the airway: the legacy of Wells and Landing. Pediatr Radiol. 42(2):215-9, 2012
                                                                          21. Kir M et al: Vascular rings: presentation, imaging strategies, treatment, and outcome. Pediatr Cardiol. 33(4):607-17, 2012
                                                                          22. McDonald ES et al: A rare case of horseshoe lung presenting in adulthood and associated with a pulmonary sling: case report and review of the literature. J Thorac Imaging. 25(3):W97-9, 2010
                                                                          23. Newman B et al: Left pulmonary artery sling--anatomy and imaging. Semin Ultrasound CT MR. 31(2):158-70, 2010
                                                                          24. Backer CL et al: Tracheal reconstruction in children with unilateral lung agenesis or severe hypoplasia. Ann Thorac Surg. 88(2):624-30; discussion 630-1, 2009
                                                                          25. Baden W et al: Comparison of imaging techniques in the diagnosis of bridging bronchus. Eur Respir J. 31(5):1125-31, 2008
                                                                          26. Yu JM et al: The prevalence and clinical impact of pulmonary artery sling on school-aged children: a large-scale screening study. Pediatr Pulmonol. 43(7):656-61, 2008
                                                                          27. Lee KH et al: Use of imaging for assessing anatomical relationships of tracheobronchial anomalies associated with left pulmonary artery sling. Pediatr Radiol. 31(4):269-78, 2001
                                                                          28. Woods RK et al: Vascular anomalies and tracheoesophageal compression: a single institution's 25-year experience. Ann Thorac Surg. 72(2):434-8; discussion 438-9, 2001
                                                                          29. Berdon WE: 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. Radiology. 216(3):624-32, 2000
                                                                          30. Donnelly LF et al: The spectrum of extrinsic lower airway compression in children: MR imaging. AJR Am J Roentgenol. 168(1):59-62, 1997
                                                                          31. Siripornpitak S et al: Pulmonary artery sling: anatomical and functional evaluation by MRI. J Comput Assist Tomogr. 21(5):766-8, 1997
                                                                          32. Newman B et al: Left pulmonary artery sling: diagnosis and delineation of associated tracheobronchial anomalies with MR. Pediatr Radiol. 26(9):661-8, 1996
                                                                          33. Katz M et al: Spiral CT and 3D image reconstruction of vascular rings and associated tracheobronchial anomalies. J Comput Assist Tomogr. 19(4):564-8, 1995
                                                                          34. Berdon WE et al: Vascular anomalies and the infant lung: rings, slings, and other things. Semin Roentgenol. 7(1):39-64, 1972