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Images in paediatrics
Pulmonary sling complex with complete tracheal rings and VSD with an unexpected ALCAPA
  1. Katharine Elizabeth Orr1,
  2. Sophie Maxwell2,
  3. Ruth Allen3,
  4. Kerrie McAllister4,
  5. Lindsay Hunter2
  1. 1 Department of Radiology, Royal Hospital for Children, Glasgow, UK
  2. 2 Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
  3. 3 Department of Radiology, Royal Hospital for Children, Glasgow, UK
  4. 4 Department of Paediatric Otorhinolaryngology, Royal Hospital for Children, Glasgow, UK
  1. Correspondence to Dr Katharine Elizabeth Orr, Radiology, Royal Hospital for Children Glasgow, Glasgow G51 4TF, UK; katharine.orr{at}

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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 …

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  • Contributors KEO completed a literature review, first draft and revised subsequent drafts, as well as preparing the figures. SM, RA, KM and LH edited drafts. KEO, RA and LH selected the case for writing a case report. All authors approved final draft and figures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.