Radiologic Case of the Month

Clinical History.—This child was referred for evaluation at the age of 2 years because of a heart murmur noted during routine care. She had been treated once at age 6 months for pneumonia but otherwise had not been ill. There was no history of stridor. Her growth and development had not been remarkable, although her speech development seemed somewhat delayed. The physical examination was compatible with a small patent ductus arteriosus. The electrocardiogram was normal. Routine barium swallow roentgenograms were obtained and cardiac catheterization performed.

Denouement and Discussion 

Pulmonary Artery Sling Syndrome  The posteroanterior and lateral chest roentgenograms show (Fig 1 and 2) an anterior compression on the esophagus at the level of the carina. A right ventricular cineangiogram (Fig 3) shows an anomalous left pulmonary artery rising from the right pulmonary artery. The bronchogram (Fig 4) shows compression of the bronchus to the right upper lobe and of