A case of a pulmonary artery sling misdiagnosed as refractory asthma for 20 years

Abstract

Key Clinical MessageWe report the case of a 25‐year‐old woman with a pulmonary artery sling who was misdiagnosed as having childhood‐onset refractory asthma for approximately 20 years. The use of computed tomography may be useful for diagnosing this rare condition.

An Adult Case of Pulmonary Artery Sling Accompanied by Tracheobronchomalacia

“…Unlike infantile cases, most adult cases are asymptomatic or mildly symptomatic (15). To our knowledge, there are only three documented adult cases of PA sling accompanied by tracheobronchial anomalies, similar to the present case (3,4,6). All patients were women who presented with symptoms of recurrent pneumonia or wheezing (Table).…”

“…Presentation of PA sling in adults is rare (3-10). Unlike infantile cases, most adult cases are asymptomatic or mildly symptomatic (15).…”

“…Ventilatory support may be necessary if the airway stenosis is very severe (2). PA sling is rarely reported in adulthood (3-10).…”

Airway management in vascular central airway obstruction: a literature review

“…Vascular rings [35] -Double aortic arch [44][45][46][47][48][49][50][51][52][53][54] -Right-sided double aortic arch and descending aorta [55] -Double aortic arch with Kommerell's diverticulum [63] -Left aortic arch with right ligamentum arteriosum and right descending aorta [33] with aberrant right subclavian artery [36] with aberrant right subclavian artery and Kommerell's diverticulum [38] -Right aortic arch [64] with aberrant left subclavian artery and left ligamentum arteriosum [36,39,43] with aberrant left subclavian artery and Kommerell's diverticulum [38,[40][41][42][43] -Pulmonary artery sling [56][57][58] Congenital aortic arch anomaly -Kommerell's diverticulum [21,22,[59][60][61] -Cervical aortic arch aneurysm [62] Congenital innominate artery anomaly -Anomalous innominate artery [65] Congenital heart diseases Pulmonary atresia and major aortopulmonary collateral arteries in Tetralogy of Fallot [32] Atrial septal defect [66] CAO, central airway obstruction.…”

Pulmonary artery sling diagnosed and corrected in an 11-year-old boy with refractory pulmonary infections and childhood-onset asthma

“…Pulmonary artery sling (PAS) is a congenital anomaly in which a pulmonary artery branch crosses respiratory tract organs (trachea or main bronchi) from the opposite side with their overlapping and airway obstruction. The defect is usually diagnosed in early infancy because of an evident clinical manifestation related more to respiratory than circulatory problems [ 1 ]. This rare anomaly is usually identified in the settings of complex congenital anomalies, although it can occur as an isolated problem or partial form with usually coexisting tracheal stenosis [ 2 ].…”