Abdullah ÖZYURT, Nazmi NARİN, Kazım UZUM, Faruk SERHATLIOĞLU, Mustafa ARGUN, Ertuğrul MAVİLİ, Ali BAYKAN

Tekrarlayan aspirasyon pnomonisinin nadir bir nedeni: pulmoner arter sling

Pulmoner arter sling (PAS), sol pulmoner arterin sağ pulmoner arter arka kısmından köken alarak anormal seyirle sol akciğer hilusunda sonlandığı en nadir vasküler ring anomalisidir. Altı aylık bir kız olgu beslenmeyi takiben öksürük, nefes darlığı, hırıltı ve morarma şikâyetleriyle acil ünitemize getirildi. Aspirasyon pnömonisi tanısı ile yatırılan olgunun sol ana bronşundan bronkoskopiyle katı yemek artıkları çıkarıldı. Onbeş aylıkken aynı şikâyetlerle ikinci başvurusunda çekilen toraks tomografisiyle PAS tanısı konuldu. Toraks tomografisinde ayrıca sol ana bronş basısı ve hipoplazisi vardı. On beş aylıkken cerrahi yolla slingi düzeltildi. Cerrahi sonrası solunum ve beslenme şikâyetleri olmadı. En son kontrolünde 22 aylık olan hasta polikliniğimizde sorunsuz olarak izlenmektedir. Pulmoner arter sling, daha çok tekrarlayan wheezing atakları, inatçı öksürük, kronik stridor, kusma ve disfaji gibi şikâyet ve bulgularla başvurur. Tekrarlayan aspirasyon pnomonisi kliniğinde PAS tanısı nadirdir. Anormal seyirli sol pulmoner arter, seyri nedeniyle trakea veya sağ pulmoner artere bası yapar. Olgu atipik anatomisi ve prezantasyonu nedeniyle sunulmuştur.

Pulmonary artery sling: a rare cause of recurrent aspiration pneumonia

Pulmonary artery sling is the rarest vascular ring anomaly that left pulmonary artery originates from posterior of right pulmonary artery with an abnormal course and ends in hilus of the left lung. A Six months old girl was brought to our emergency unit for cough, dyspnea, and cyanosis which were started after feeding. She was hospitalized with the diagnosis of aspiration pneumonia and solid food remnants were aspirated from the left main bronchus by bronchoscopy. In her second hospitalization when she was 15 months old, pulmonary artery sling was seen in her thoracic tomography and was corrected by surgery. Hypoplasia and compression of left main bronchus were also noted in her thoracic tomography. She was 22 months old on her last visit and is followed by our outpatient clinic without any problems. Recurrent wheezing episodes, brassy cough, chronic stridor, vomiting, and dysphagia are the main presenting signs and symptoms of pulmonary artery sling. PAS diagnosis is rare for recurrent aspiration pneumonia. Due to abnormal course of the left pulmonary artery it presses over trachea or right pulmonary artery. The presentation of this case was considered for its atypical anatomy and clinical presentation.

PDF

___

1. Contro S, Miller RA, White M, Potts WJ. Bronchial obstruction due to pulmonary artery anomalies. I. Vascular sling. Circulation 1958;17:418-23.
2. Yu JM, Liao CP Ge S, Weng ZC, Hsiung MC, Chang JK, et al. , The prevalence and clinical impact of pulmonary artery sling on school-aged children: a large-scale screening study. Pediatr Pulmonol 2008;43:656-61.
3. Oguz B, Alan S, Ozcelik U, Haliloglu M. Horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of upper lobe bronchi. Pediatr Radiol 2009;39:1002-5.
4. Dodge-Khatami A, Tulevski II, Hitchcock JF, de Mol BA, Bennink GB. Vascular rings and pulmonary arterial sling: from respiratory collapse to surgical cure, with emphasis on judicious imaging in the hi-tech era. Cardiol Young 2002;12:96-104.
5. Chen SJ, Lee WJ, Lin MT, Wang JK, Chang CI, Chiu IS, et al. Left pulmonary artery sling complex: computed tomography and hypothesis of embryogenesis. Ann Thoac Surg 2007;84:1645-50.
6. Kelly AC, Philip MB, David AW, Armin E. Tracheomalacia and traceobronchomalacia in children and adults: an in-depth review. Chest 2005;127:984-1005.
7. Collins RT 2nd, Weinberg PM, Goldmuntz E, Harris M. Images in cardiovascular medicine. Partial anomalous left pulmonary artery. Circulation 2009;119:2405-7
8. Owayed AF, Campbell DM, Wang EE. Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med 2000;154:190-4.
9. Ma GQ, Li ZZ, Li XF, Peng Y, DU ZD, Jin LZ, et al. Congenital vascular rings: a rare cause of respiratory distress in infants and children. Chin Med J 2007;120:1408-12.
10. Uçar S, Zorlu P Metin O, Orün UA. Pulmonary artery sling ,as a cause of recurrent wheezing in children. Tuberk toraks 2010;58:311-5.
11. Song ZW, Xu CY, Ge W, Zhao YP Chen MK, Wu AQ, et al. The , diagnostic value of MSCT multi-dimensional reconstructions for congenital vascular ring with tracheal stenosis. Zhonghua Yi Xue Za Zhi 2011;91:619-22.
12. Backer CL, Russell HM, Kaushal S, Rastatter JC, Rigsby CK, Holinger LD. Pulmonary artery sling: current results with cardiopulmonary bypass. J Thorac Cardiovasc Surg 2012;143:144-51.
13. Wang JH, Ding GC, Zhang MY, Liu M, Niu HY. Clinical and imaging features of pulmonary artery sling in infants without significant hemodynamic changes. Chin Med J (Engl) 2011;124:3412-4.