|
CLINICAL HISTORY:
A 34-years-old lady
enjoyed good past health. Routine chest radiograph showed reduced
left lung volume and right-sided aortic arch. Pulmonary angiogram,
aortogram and innominate arteriogram were performed.
DIAGNOSIS:
Interruption of left pulmonary artery with right-sided aortic arch.
DISCUSSION:
Pulmonary arteriography reveals single trunk outflow tract with supply to
right lung while the left pulmonary artery is absent. Right-sided
aortic arch is evident.
Left lung is being supplied via hypertrophied collaterals arising from the
left internal mammary artery as well as from the thoracic branches of left
subclavian artery. It is better shown on angiogram performed via
selective catheterization of the left innominate artery. Features are
suggestive of interruption of left pulmonary artery with right-sided aortic
arch.
Congenital absence of one pulmonary artery is a rare entity, with an
estimated prevalence of 1 in 200,000. In proximal interruption, the
pulmonary artery ends blindly at the hilum, and blood is supplied to the
lung through collateral systemic vessels, mainly bronchial arteries but
also transpleural branches of the intercostal, internal mammary,
subclavian, and innominate arteries.
Interruption
of the left pulmonary artery is usually associated with right aortic arch
and other congenital cardiovascular anomalies, most commonly tetralogy of
Fallot. Right pulmonary artery interruption is more common than left, and
it is an isolated finding in most instances.
|
