Multimodality imaging and surgical management of a rare combination: type 2A bridging bronchus, pulmonary artery sling, and atrial septal defect, a case report

Abstract

We report the case of a 15-year-old female presenting with exertional syncope and a history of refractory respiratory symptoms. Comprehensive preoperative multimodality imaging—including echocardiography, multi-detector computed tomography (MDCT) with three-dimensional reconstruction, and bronchoscopy—revealed a rare complex of congenital anomalies: a type 2 A bridging bronchus (BB), a pulmonary artery sling (PAS), and an atrial septal defect (ASD). Crucially, imaging confirmed the absence of significant tracheal stenosis, thereby obviating the need for tracheoplasty. The patient successfully underwent surgical repair via median sternotomy on cardiopulmonary bypass, which included reimplantation of the left pulmonary artery and patch closure of the ASD. Postoperative MDCT confirmed patency of the reconstructed pulmonary artery and the patient’s symptoms resolved. This case underscores the indispensable role of advanced imaging in the diagnosis and surgical planning of complex congenital cardiopulmonary anomalies, particularly for guiding a tailored surgical approach in the setting of rare associations like BB and PAS.