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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}nhs.net

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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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