CTICasesCongenital Anomalies: Pulmonary Sling, Left SVC, Complete Tracheal Rings, Left Isomerism, and Foregut Duplication Cyst
Imaging findings
Chest CT demonstrates a complex constellation of congenital anomalies in a 68-year-old patient. A pulmonary sling is present, with the left pulmonary artery originating from the right pulmonary artery and coursing between the trachea and the esophagus. There is a persistent left superior vena cava (SVC). Adjacent to the esophagus, a fluid-attenuation cystic structure is seen, consistent with a foregut duplication cyst. Virtual bronchoscopy reveals a small trachea with complete tracheal rings, showing complete ring-like narrowing without a posterior membranous portion. Additionally, the lungs show bilateral hyparterial bronchi indicative of left pulmonary isomerism, and an absent right middle lobe.
Key takeaways
A pulmonary sling is a rare congenital vascular anomaly that is frequently associated with other developmental abnormalities. When a pulmonary sling is detected, radiologists should carefully evaluate for associated anomalies, including complete tracheal rings (which cause severe tracheal stenosis), foregut duplication cysts, persistent left SVC, and left lung isomerism. Understanding this complex spectrum of congenital anomalies is important because they may explain chronic respiratory symptoms, such as progressive shortness of breath, even when other conditions like paraesophageal hernias are repaired.
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