LEFT PULMONARY-ARTERY SLING - DIAGNOSIS AND DELINEATION OF ASSOCIATEDTRACHEOBRONCHIAL ANOMALIES WITH MR

Background. The left pulmonary artery sling anomaly (SLPA) has generat ed controversy about its diagnosis, imaging and management particularl y with regard to associated tracheobronchial anomalies. Objective. To evaluate the role of MR imaging in defining airway and vascular relati onships in SLPA. Materials and methods. Retrospective review of the im aging and clinical records of three children with SLPA who underwent M RI including three dimensional image reconstruction. MR was compared a nd correlated with other imaging methods: plain chest radiographs (3); bronchoscopy (3); barium esophagram (1); echocardiography (2); cinean giography (2). Results. MRI was vastly superior to other methods for c learly depicting airway and vascular anatomy and interrelationships. G ood quality imaging and safe sedation was easily achieved in young inf ants. MR also provided accurate noninvasive evaluation of the reconstr ucted pulmonary artery and airway postoperatively. Conclusion. MR is c apable of differentiating the two subtypes of SLPA. Specific delineati on of vascular and airway anatomy and spatial relationships is essenti al for surgical management: reimplantation of LPA in type I and both L PA reimplantation and airway reconstruction in type II because of asso ciated long segment airway stenosis.