All issues > Volume 40(5); 1997

Case Report

J Korean Pediatr Soc. 1997;40(5):709-715. Published online May 15, 1997.

Four Cases of Pulmonary Artery Sling with Bridging Bronchus

Seung A SA Lee¹, Jung Yeon JY Shim¹, Young Hwue YH Kim¹, Jae Kon JK Ko¹, In Sook IS Park¹, Soo-Jong SJ Hong¹, Chang Yee CY Hong¹

¹Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

Abstract

Pulmonary artery sling with bridging bronchus is not only rare but also difficult to diagnose unless specially sought. When young infant suffers from prolonged or recurrent wheezing, possibility of underlying anomalies of the tracheobronchial trees or great vessels should be considered, even though bronchiolitis and gastroesophageal reflux are the most common causes. We experienced four cases of pulmonary artery sling with bridging bronchus who presented with dyspnea and recurrent wheezing since infancy. Diagnosis was made using bronchoscopy, three dimensional computed tomography, echocardiography and angiography. Bridging bronchus of three patients(case 1, 2, 3) correspond to type IIA and one patient(case 4) to type IIB by Wells classification. Bronchoscopic examinations on 3 patients showed segmental bronchomalacia and near complete obstruction of bronchus by the posterior left pulmonary artery. These congenital bronchial anormalies should be included in differential diagnosis in pediatric patients with unexplained persistent and recurrent wheezing, or emphysema of unknown etiology on plain chest X-ray.

Keywords :Pulmonary artery sling, Bridging bronchus, Bronchoscopy, Three dimensional computed tomography