Case history

A 6-week-old male infant presented with increased work of breathing, faltering weight and pansystolic murmur. Chest radiograph was performed (figure 1). Echocardiography demonstrated a ventricular septal defect (VSD), low velocity left to right flow and left pulmonary artery (LPA) sling. Cardiac-gated CT angiogram demonstrated a tracheal right upper lobe bronchus and concentric narrowing of the distal airways (figure 2); subsequent bronchoscopy and bronchography confirmed complete tracheal rings. In addition to the LPA arising from the right pulmonary artery (pulmonary sling) (figure 3), an anomalous left coronary artery arose from the pulmonary artery (ALCAPA) (figure 4). There were no clinical, ECG …