Presentation
Progressive stridor and wheezing. Suspected tracheal stenosis and childhood asthma
Patient Data
There is an aberrant left pulmonary artery arising from the right pulmonary artery and coursing behind the trachea at the level of the carina and anterior to the thoracic esophagus. There is a posterior tracheal indentation best appreciated on lateral reformats. There is a mild horizontal orientation of the main bronchi ( low T-shaped carina) appreciated on coronal reformats and axial CT imaging.
There is a prominent aortic arch impression on the trachea.
There are no other associated cardiomediastinal, lung parenchymal, diaphragmatic or thyroid abnormalities on CT imaging.
Case Discussion
An example of an aberrant left pulmonary artery (pulmonary sling). During its course from right to left, between the trachea and the thoracic esophagus, the aberrant pulmonary artery indents the trachea posteriorly and the esophagus anteriorly. This explains the presence of respiratory and esophageal symptoms in these neonates, infants and children. In this patient, wheezing was present at an early age and pediatric asthma was diagnosed and treated as such, until the stridor developed and the patient was referred for CT imaging.
Case courtesy: Dr VKS Bhagwandas.
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