Anomalous left coronary artery masquerading as infantile bronchiolitis

Four infants less than six months of age with anomalous left coronary artery from the pulmonary artery who present with symptoms of wheezing are described. All had cardiomegaly on chest radiographs and because of wheezing received beta-agonist agents (albuterol alone or with epinephrine). One developed cardiopulmonary collapse secondary to supraventricular tachycardia after administration of these agents. The literature is reviewed for utility of chest radiographs in infants presenting with wheezing and for the efficacy of beta-adrenergic agents in infants less than six months of age. The authors suggest that physicians have a low threshold for obtaining a chest radiograph prior to treating a first-time wheezing infant less than six months of age with a beta-agonist agent.