PMC8566341_01
Radiographic evaluation of the PAS, tracheobronchial abnormalities, and neurological lesions through CT and MRI scans. (A) Preoperative CTA showing the anomalous origin of LPA from the posterior aspect of RPA. (B,C) Postoperative three-dimensional reconstruction of CT showing a lower level of bronchial bifurcation at T6 (yellow arrow) and a long RMB with bronchial divisions identical to left bronchial type (yellow arrowhead), associated with a stenotic segment in the distal trachea (white arrow); (D-F) Axial T1-weighted, T2-weighted, and T2-FLAIR brain MRI, respectively, displaying symmetrical signal abnormalities throughout the gray matter, white matter, and deep nuclei (red arrowhead), and extensive cortical necrosis (red asterisk), cerebrum atrophy and ventriculomegaly (red arrow). PAS, pulmonary artery sling; CTA, computed tomography angiography; LPA, left pulmonary artery; RPA, right pulmonary artery; RMB, right main bronchus; FLAIR, fluid attenuated inversion recovery.
fcvm-08-743848-g0001.jpg
PMC8566341_01_fcvm-08-743848-g0001.jpg
F1
To better delineate the anatomy of the PAS and to evaluate the airway, a computed tomography angiography (CTA) was undergone at 8 months of age, demonstrating that the LPA had its origin from RPA and coursed between the esophagus and trachea to the left lung hilum (shown in Figure 1A). Moreover, several consolidative opacities in the inferior lobes of both lungs were found (shown in Figures 1B,C). Figures 1D-F).
Bronchoscopy image showing extensive airway defects accompanied by mucosal hyperemia and edema. (A,B) long-segment stenosis (yellow arrowhead) with complete tracheal cartilage rings (O-rings) (yellow arrow) at the upper and lower trachea, respectively; (C) narrowing of the carina with increased angle between LMB and RMB (yellow arrowhead); (D) stenosis at RMB (yellow arrowhead); (E) absence of the orifice of RMLB at a level where the orifice of RLLB (yellow circle) normally existed; (F) stenosis at segmental bronchi beyond RMB (yellow arrowhead); (G,H) variable narrowing in subsegmental bronchi of LLLB (yellow arrowhead). LMB, left main bronchus; RMB, right main bronchus; RMLB, right middle lobe bronchus; RLLB, right lower lobe bronchus; LLLB, left lower lobe bronchus.
fcvm-08-743848-g0002.jpg
PMC8566341_01_fcvm-08-743848-g0002.jpg
F2
Additionally, extensive mucosal swelling with surrounding hyperemia and sticky secretions was prominent as well (shown in Figure 2).
The timeline showcasing relevant data from the episode of care. PAS, pulmonary artery sling; CTA, computed tomography angiography; LPA, left pulmonary artery; MV, mechanical ventilation; 3D, three-dimensional; CN, cortical necrosis; CA, cerebrum atrophy; NA, not available.
fcvm-08-743848-g0003.jpg
PMC8566341_01_fcvm-08-743848-g0003.jpg
F3
Finally, the parents of the patient abandoned treatment due to economic factors and took the baby home. Figure 3 summarized the timeline with relevant data from the episode of care in this case.