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American Journal of Roentgenology, Vol 95, 598-610, Copyright © 1965 by American Roentgen Ray Society

ANOMALOUS ORIGIN OF THE LEFT PULMONARY ARTERY FROM THE RIGHT PULMONARY ARTERY

REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

KENNETH L. JUE M.D.1, GUNAY RAGHIB M.D.1, KURT AMPLATZ M.D.1, PAUL ADAMS JR. M.D.1, and JESSE E. EDWARDS M.D.1

1 From the Department of Pathology, The Charles T. Miller Hospital, St. Paul, Minnesota, and the Departments of Pediatrics, Radiology and Pathology, University of Minnesota, Minneapolis, Minnesota

Anomalous origin of the left pulmonary artery from the right pulmonary artery is a rare entity. Its effects are usually noted in infancy and are characterized by obstructive symptoms of the respiratory tract and recurrent pneumonia.

The diagnosis of anomalous origin of the left pulmonary artery from the right pulmonary may be suspected upon roentgenologic evidence of obstructive emphysema and/or atelectasis of the right lung. Indentation of the anterior aspect of the barium-filled esophagus just above the carina (best seen in lateral view) is virtually diagnostic of this condition. The exact course pursued by the anomalous left pulmonary artery may be demonstrated in frontal views of selective pulmonary arteriograms. If the course of the left pulmonary artery is obscured by the pulmonary trunk in the frontal view, a selective pulmonary arteriogram in the left anterior oblique view, and with the esophagus filled with barium, may serve well to demonstrate the exact course pursued by the anomalous left pulmonary artery.

In about 85 per cent of 23 necropsied cases (2 herein reported and 21 from the literature), death had occurred when the patient was less than 1 year old.

Associated anomalies of the tracheobronchial tree and/or of the cardiovascular system were present in about half of the cases. Most of the anomalies of the tracheobronchial tree took the form either of hypoplasia of the distal end of the trachea or of stenosis of the left bronchus.

From a review of the reported surgical experiences it is suggested that division and anastomosis of the anomalous left pulmonary artery to a position anterior and to the left of the trachea is the procedure of choice.


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