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Therapeutic strategy in a 9-month-old child with pulmonary sling: need for bronchoscopic evaluation
T Frischer1, I Holomanova, K Frenzel
1University Childrens Hospital, Department of Cardiology, University of Vienna, Währingergürtel 18-20,A-1090 Vienna, Austria.
Insights
A 9-month-old infant experienced recurrent respiratory infections due to a rare vascular anomaly, a pulmonary sling. Surgical repair of the ligamentum arteriosum resolved the tracheal stenosis, restoring airway patency and improving the child's health.
Area of Science:
- Pediatric Surgery
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Recurrent severe lower respiratory tract infections in infants can indicate underlying congenital anomalies.
- Vascular anomalies compressing the airway, such as pulmonary sling, are rare but critical diagnoses.
- Early identification and surgical intervention are crucial for managing airway obstruction in neonates and infants.
Observation:
- A 9-month-old child presented with a history of repeated severe lower respiratory tract infections.
- Bronchoscopy identified tracheal stenosis, suggesting a vascular anomaly of the great arteries.
- Further examination revealed left main stem bronchial stenosis, suspected to be caused by a ligamentum arteriosum.
Findings:
- Heart catheterization confirmed an abnormal origin of the left pulmonary artery (pulmonary sling).
- Bronchoscopic and angiographic findings supported the suspicion of a pulmonary ring.
- Surgical dissection of the ligamentum arteriosum was performed to address the vascular compression.
Implications:
- Successful surgical correction of the pulmonary sling anomaly resolved the airway stenosis.
- The infant became asymptomatic post-operation, with a patent left main bronchus.
- This case highlights the importance of considering vascular anomalies in pediatric airway obstruction and the efficacy of surgical repair.
Abstract:
A 9-month-old child presented suffering from repeated severe infections of the lower respiratory tract. Bronchoscopy revealed a tracheal stenosis, suggestive of a vascular anomaly of the great arteries. A second significant stenosis of the left main stem bronchus was observed that was suspected to be due to a ligamentum arteriosum. Heart catheterization confirmed the diagnosis of an abnormal origin of the left pulmonary artery (pulmonary sling). Based on the bronchoscopic and angiographic findings a pulmonary ring was suspected. A dissection of the ligamentum arteriosum was performed. At readmission 4 weeks postoperatively the child was asymptomatic and the left main bronchus was patent.