Early Diagnosis of Left Pulmonary Artery Sling During First Week of Life in a Term Baby Boy: A Case Report

Abstract

Pulmonary artery sling is a rare cause of neonatal respiratory distress. Most patients with pulmonary artery sling present in early infancy with stridor and signs of respiratory distress. Diagnosis of pulmonary artery sling, like other vascular ring anomalies, can be made using various imaging modalities, and management encompasses urgent surgical repair as a definitive treatment. This is the first paper to report a successfully managed case of an early detected left pulmonary artery sling during the first week of life in a term male patient and to evaluate the diagnostic characteristics in alliance with it. CAse REports (CARE) guidelines were followed for reporting our case. In brief, a case of full-term baby boy was born by normal vaginal delivery and shortly after birth, the baby started to have respiratory distress not improving on O₂. Chest X-ray revealed right upper lobe atelectasis which persisted despite mechanical ventilation and antibiotics. A thoracic CT scan showed developmental malformation of left main pulmonary artery, confirming the diagnosis of "left pulmonary artery sling." The baby was immediately operated. One week later, chest X-ray showed gradual improvement and the baby was discharged home with no postoperative complications. Hence, we suggest that pulmonary artery sling should be suspected in any neonate with respiratory distress and unilateral lung field opacification. The fact that there are only very few reports on this disease raises a need to establish and implement well-defined guidelines and criteria for early diagnosis and management of pulmonary artery sling among newborns.

Keywords: atelectasis; pulmonary artery sling; respiratory distress; surgical repair; vascular anomaly.

Figure 1. Chest X-rays revealing right-sided infiltrates (A) and right lung atelectasis (B).

"R" signifies right side and "L" signifies left side

Figure 2. Thoracic CT scan showing developmental retro-tracheal malformation of the left main pulmonary artery originating from the right with compression of the origin of the right main bronchus (unlabeled in A and labeled in B).

DA, descending aorta; LMB, left main bronchus; RMB, right main bronchus; RPA, right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery

Figure 3. Chest X-ray showing gradual improvement of the patient with minimal right-sided infiltrates and absence of lung atelectasis.

"L" signifies left side