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Figure 7c. (a) Diagram of anomalous left pulmonary artery, or pulmonary sling. Br. = bronchus, L.A. = ligamentous remnant of ductus arteriosus, L.L.L. = left lower lobe, L.P.A. = left pulmonary artery (in anomalous retrotracheal course), L.U.L. = left upper lobe, P.T. = pulmonary trunk, R.L.L. = right lower lobe, R.M.L. = right middle lobe, R.P.A. = right pulmonary artery, R.U.L. = right upper lobe. (Reprinted, with permission, from reference 18.) (b) Lateral airway esophagrams show an anomalous left pulmonary artery (arrow) passing between the esophagus behind it and trachea in front of it. (c) Transverse T1-weighted MR image (750/30) obtained in another patient shows an anomalous left pulmonary artery (arrow) passing posteriorly and to the left between the trachea and the esophagus. Note the emphysematous right lung. The patient survived following surgical correction. (Image courtesy of S. Sane, MD, Minneapolis, Minn.) (d) Autopsy findings in an anomalous left artery, or pulmonary sling, with long-segment tracheal stenosis. Patient had an incidental coexistent anomalous right subclavian artery passing behind the esophagus. The tracheal stenosis, as viewed externally, is reflected in the change in diameter of the trachea involving approximately the last eight tracheal rings above the carina. Note the characteristic inverted "T" appearance of the splayed right and left main bronchi. L = left pulmonary artery, R = right pulmonary artery, S = anomalous subclavian artery. (Reprinted, with permission, from reference 11.) (e) Anteroposterior tracheobronchogram shows severe complete O-ring tracheal stenosis. Note the inverted trachea (T). The distal trachea is narrower than the bronchi. The patient, who also had a tracheal bronchus (arrow) to the right upper lobe, died after recurrent respiratory decompensations that seemed to be bronchiolitis. An anomalous left pulmonary artery was detected only at autopsy. (Image courtesy of B. Benjamin, MD, Royal Alexandra Children’s Hospital, Sydney, Australia.) (f) Histologic trachea specimen obtained at autopsy in the patient in e shows complete O-ring tracheal stenosis. (Image courtesy of P. Bale, MD, Royal Alexandra Children’s Hospital, Sydney, Australia.) (g) Three-dimensional reconstructed MR image (750/30) obtained in another patient, as viewed from above, shows an anomalous left pulmonary artery, or pulmonary sling. This patient also had an anomalous right subclavian artery as an incidental finding and tracheal stenosis from complete rings. The left pulmonary artery (L) arises from the right pulmonary artery (R) and passes to the left behind the trachea and left main bronchus (white). M = main pulmonary artery. (Image courtesy of Beverley Newman, MD, Children’s Hospital, Pittsburgh, Pa.)