CTICasesPulmonary Artery Sling Incidentally Discovered on Lung Cancer Screening CT
Imaging findings
Low-dose lung cancer screening CT in a 60-year-old smoker demonstrates a mass-like density posterior to the trachea. Subsequent contrast-enhanced CT reveals this is a left pulmonary artery arising anomalously from the right pulmonary artery and coursing between the trachea and esophagus to reach the left hilum, consistent with a pulmonary artery sling. There is asymmetric emphysema with cystic changes predominantly on the left, possibly related to chronic mild airway compression by the sling. Bronchoscopy shows the tracheal rings are intact without branching airway abnormality. The patient is managed conservatively.
Key takeaways
Pulmonary artery sling (anomalous left pulmonary artery arising from the right pulmonary artery) can present incidentally as a mass-like density posterior to the trachea on CT, which in the appropriate clinical context of a smoker undergoing lung cancer screening may initially raise concern for mediastinal malignancy. The key diagnostic finding is the anomalous vessel coursing between trachea and esophagus on CT. Asymmetric emphysema, predominantly ipsilateral to the sling, may develop from chronic mild bronchial compression. Conservative management is appropriate in asymptomatic adults.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Takayasu Arteritis with Acute Intramural Hemorrhage Mimicking Intramural HematomaAutoimmune
- Relapsing Polychondritis with Tracheal and Costal Cartilage InvolvementAutoimmune
- Large Right Upper Lobe Pulmonary Vein with Mass Effect on Bronchus IntermediusCongenital
- Pulmonary Alveolar Proteinosis — Geographic Crazy PavingAutoimmune
- Idiopathic Pulmonary Hemosiderosis with Severe Pulmonary HypertensionILD
- Dual Left Anterior Descending Artery (Dual LAD) Coronary VariantCongenital
- Multiple Myeloma with Pulmonary Plasmacytoma InvolvementNeoplastic
- Lateral Costal Artery Embolization Coils in a LIMA Bypass PatientIatrogenic
See all cases from September 14, 2017 →
Related Congenital cases
- Congenital Systemic-to-Pulmonary Artery Fistula — Internal Mammary Artery to Left PA
- Complex Pleuropulmonary Lymphatic-Venous Malformation
- Right Aortic Arch with Mirror-Image Branching and Right Ligamentum Arteriosum
- Uncorrected Ventricular Septal Defect with Bronchial Artery Aneurysm
- Anterior Mediastinal Lymphangioma
- Cor Triatriatum Dexter and Sinister