Image in Cardiology
Pulmonary artery sling: An incidental finding
Sling da artéria pulmonar: um achado acidental
Joana O. Miranda
, José Monterroso, Jorge Moreira, Maria João Baptista
Corresponding author
Serviço de Cardiologia Pediátrica, Centro Hospitalar São João, Porto, Portugal
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(B) transthoracic echocardiogram revealing left ventricular (LV) concentric hypertrophy; (C) transesophageal echocardiogram showing LV concentric hypertrophy; (D) cardiac magnetic resonance imaging revealing infiltration of the myocardium and pericardium (arrow); (E) diffuse myocardial infiltration on macroscopic post-mortem examination; (F) histologic examination (hematoxylin & eosin, ×200) revealing infiltration of the myocardium by lymphocytes; (G) histologic examination (CD3, ×200) showing CD3-positive lymphocytes; (H) histologic examination (Ki-67, ×200) revealing a high proliferative index.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Carrilho-Ferreira, Marco Ferreira, Cristina Ferreira, Maria José Correia, António Nunes Diogo, Luís Brás Rosário" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Carrilho-Ferreira" ] 1 => array:2 [ "nombre" => "Marco" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Ferreira" ] 3 => array:2 [ "nombre" => "Maria José" "apellidos" => "Correia" ] 4 => array:2 [ "nombre" => "António" "apellidos" => "Nunes Diogo" ] 5 => array:2 [ "nombre" => "Luís" "apellidos" => "Brás Rosário" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255114001590" "doi" => "10.1016/j.repc.2014.02.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001590?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001846?idApp=UINPBA00004E" "url" => "/21742049/0000003300000078/v2_201411090043/S2174204914001846/v2_201411090043/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2174204914001792" "issn" => "21742049" "doi" => "10.1016/j.repce.2014.01.018" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "487" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2014;33:477-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3042 "formatos" => array:3 [ "EPUB" => 182 "HTML" => 2363 "PDF" => 497 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Active fixation pacemaker lead perforating cardiac wall" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "477" "paginaFinal" => "478" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Elétrodo de fixação ativa do <span class="elsevierStyleItalic">pacemaker</span> perfurando parede cardíaca" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1400 "Ancho" => 1400 "Tamanyo" => 390868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Transthoracic echocardiography, subcostal view, showing the pacemaker lead perforating the right ventricle (arrow); 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Miranda, José Monterroso, Jorge Moreira, Maria João Baptista" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Joana O." "apellidos" => "Miranda" "email" => array:1 [ 0 => "joanam@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "José" "apellidos" => "Monterroso" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Moreira" ] 3 => array:2 [ "nombre" => "Maria João" "apellidos" => "Baptista" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia Pediátrica, Centro Hospitalar São João, Porto, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Sling</span> da artéria pulmonar: um achado acidental" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1056 "Ancho" => 1632 "Tamanyo" => 107501 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomographic angiography reveals anomalous origin of the LPA from the posterior aspect of the RPA. The aberrant LPA (black arrow) runs behind the trachea as it courses to the left pulmonary hilum, causing a mild compression of the origin of the LPA.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A previously healthy one-month infant was referred to our institution due to a heart murmur. The transthoracic echocardiogram showed the pulmonary trunk giving rise to the right pulmonary artery (RPA), but the left pulmonary artery (LPA) was not identified in its usual location. Instead the LPA was arising from the RPA and coursing leftward behind the trachea, with a turbulent flow (peak velocity 1.5 m/s) (Video 1). An associated ostium secundum atrial septal defect was diagnosed. The suspected diagnosis of pulmonary artery sling was confirmed by computed tomographic angiography. The LPA was seen originating from the posterior aspect of the RPA and coursing over the right mainstem bronchus and then from right to left, posterior to the trachea and anterior to the esophagus, to reach the hilum of the left lung, and causing a mild compression of the origin of the LPA (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Besides the pulmonary artery sling and the atrial septal defect, a partial anomalous pulmonary venous return was identified, with the left superior pulmonary vein draining in the left brachiocephalic vein (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The anomalous origin of the LPA known as pulmonary artery sling is a rare form of vascular ring. In the vast majority of patients it is associated with respiratory symptoms in the first year of life, due to tracheal stenosis, and with a high mortality rate if there is no surgical intervention. In our case, the heart murmur led to early medical attention. The findings on echocardiography and computed tomographic angiography allowed an early non-invasive diagnosis, avoiding a potentially severe and life-threatening acute presentation.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Ethical disclosures</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 1 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-02" "fechaAceptado" => "2014-01-27" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1056 "Ancho" => 1632 "Tamanyo" => 107501 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomographic angiography reveals anomalous origin of the LPA from the posterior aspect of the RPA. The aberrant LPA (black arrow) runs behind the trachea as it courses to the left pulmonary hilum, causing a mild compression of the origin of the LPA.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 709 "Ancho" => 998 "Tamanyo" => 88937 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Computed tomographic angiography reveals partial anomalous pulmonary venous return consisting of left superior pulmonary vein (white arrow) draining in the left brachiocephalic vein.</p>" ] ] 2 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Video 1" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1146280 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography (parasternal short-axis, 2D and color Doppler) shows the pulmonary trunk in continuity with the RPA and this branch giving rise to the LPA, which courses around the trachea, creating a pulmonary artery sling.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000078/v2_201411090043/S2174204914001858/v2_201411090043/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000078/v2_201411090043/S2174204914001858/v2_201411090043/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914001858?idApp=UINPBA00004E" ]
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| 2016 July | 16 | 4 | 20 |
| 2016 June | 13 | 4 | 17 |
| 2016 May | 24 | 2 | 26 |
| 2016 April | 24 | 1 | 25 |
| 2016 March | 22 | 4 | 26 |
| 2016 February | 25 | 14 | 39 |
| 2016 January | 24 | 5 | 29 |
| 2015 December | 13 | 3 | 16 |
| 2015 November | 18 | 2 | 20 |
| 2015 October | 30 | 6 | 36 |
| 2015 September | 26 | 5 | 31 |
| 2015 August | 28 | 6 | 34 |
| 2015 July | 12 | 3 | 15 |
| 2015 June | 14 | 1 | 15 |
| 2015 May | 20 | 3 | 23 |
| 2015 April | 21 | 10 | 31 |
| 2015 March | 14 | 1 | 15 |
| 2015 February | 17 | 4 | 21 |
| 2015 January | 19 | 3 | 22 |
| 2014 December | 21 | 7 | 28 |
| 2014 November | 20 | 8 | 28 |
| 2014 October | 40 | 9 | 49 |
| 2014 September | 21 | 6 | 27 |
Show all
