CTICasesPulmonary Artery Sling Incidentally Discovered on Lung Cancer Screening CT
[...]. Pulmonary Artery Sling Incidentally Discovered on Lung Cancer Screening CT. CTICases. Published September 14, 2017. https://str-case-explorer.pages.dev/c/3vyxv
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.
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