Pediatric Radiology

, Volume 41, Issue 11, pp 1440–1454 | Cite as

Common and uncommon vascular rings and slings: a multi-modality review

  • Jonathan R. DillmanEmail author
  • Anil K. Attili
  • Prachi P. Agarwal
  • Adam L. Dorfman
  • Ramiro J. Hernandez
  • Peter J. Strouse
Pictorial Essay


Vascular rings and pulmonary slings are congenital anomalies of the aortic arch/great vessels and pulmonary arteries, respectively, that commonly present early during infancy and childhood with respiratory and/or feeding difficulties. The diagnosis of these conditions frequently utilizes a multi-modality radiological approach, commonly utilizing some combination of radiography, esophagography, CT angiography and MR angiography. The purpose of this pictorial review is to illustrate the radiological findings of common and uncommon vascular rings and pulmonary slings in children using a state-of-the-art multi-modality imaging approach.


Vascular ring Pulmonary sling Children MR angiography CT angiography Esophagography Radiography 


  1. 1.
    Berdon WE, Baker DH (1972) Vascular anomalies and the infant lung: rings, slings, and other things. Semin Roentgenol 7:39–64PubMedCrossRefGoogle Scholar
  2. 2.
    Hernanz-Schulman M (2005) Vascular rings: a practical approach to imaging diagnosis. Pediatr Radiol 35:961–979PubMedCrossRefGoogle Scholar
  3. 3.
    Simoneaux SF, Bank ER, Webber JB et al (1995) MR imaging of the pediatric airway. Radiographics 15:287–298PubMedGoogle Scholar
  4. 4.
    Lowe GM, Donaldson JS, Backer CL (1991) Vascular rings: 10-year review of imaging. Radiographics 11:637–646PubMedGoogle Scholar
  5. 5.
    Castañer E, Gallardo X, Rimola J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349–371PubMedCrossRefGoogle Scholar
  6. 6.
    Lee KH, Yoon CS, Choe KO et al (2001) Use of imaging for assessing anatomical relationships of tracheobronchial anomalies associated with left pulmonary artery sling. Pediatr Radiol 31:269–278PubMedCrossRefGoogle Scholar
  7. 7.
    Zhong YM, Jaffe RB, Zhu M et al (2010) CT assessment of tracheobronchial anomaly in left pulmonary artery sling. Pediatr Radiol 40:1755–1762PubMedCrossRefGoogle Scholar
  8. 8.
    Espinosa L, Agarwal P (2008) Adult presentation of right lung agenesis and left pulmonary artery sling. Acta Radiol 49:41–44PubMedCrossRefGoogle Scholar
  9. 9.
    Browne LP (2009) What is the optimal imaging for vascular rings and slings? Pediatr Radiol 39(Suppl 2):S191–S195PubMedCrossRefGoogle Scholar
  10. 10.
    Dillman JR, Hernandez RJ (2009) Role of CT in the evaluation of congenital cardiovascular disease in children. AJR 192:1219–1231PubMedCrossRefGoogle Scholar
  11. 11.
    Kellenberger CJ (2010) Aortic arch malformations. Pediatr Radiol 40:876–884PubMedCrossRefGoogle Scholar
  12. 12.
    Schlesinger AE, Mendeloff E, Sharkey AM et al (1995) MR of right aortic arch with mirror-image branching and a left ligamentum arteriosum: an unusual cause of a vascular ring. Pediatr Radiol 25:455–457PubMedCrossRefGoogle Scholar
  13. 13.
    Schlesinger AE, Krishnamurthy R, Sena LM et al (2005) Incomplete double aortic arch with atresia of the distal left arch: distinctive imaging appearance. AJR 184:1634–1639PubMedGoogle Scholar
  14. 14.
    Holmes KW, Bluemke DA, Vricella LA et al (2006) Magnetic resonance imaging of a distorted left subclavian artery course: an important clue to an unusual type of double aortic arch. Pediatr Cardiol 27:316–320PubMedCrossRefGoogle Scholar
  15. 15.
    Hilmes M, Hernandez R, Devaney E (2007) Markedly hypoplastic circumflex retroesophageal right aortic arch: MR imaging and surgical implications. Pediatr Radiol 37:63–67PubMedCrossRefGoogle Scholar
  16. 16.
    Dominguez R, Oh KS, Dorst JP et al (1978) Left aortic arch with right descending aorta. AJR 130:917–920PubMedGoogle Scholar
  17. 17.
    McLeary MS, Frye LL, Young LW (1998) Magnetic resonance imaging of a left circumflex aortic arch and aberrant right subclavian artery: the other vascular ring. Pediatr Radiol 28:263–265PubMedCrossRefGoogle Scholar
  18. 18.
    Ahluwalia GS, Rashid AG, Griselli M et al (2007) Hypoplastic circumflex retroesophageal right-sided cervical aortic arch with unusual vascular arrangement and severe coarctation. Ann Thorac Surg 84:1014–1016PubMedCrossRefGoogle Scholar
  19. 19.
    Ahn KS, Yong HS, Lee JW et al (2007) Right circumflex retro-oesophageal aortic arch with coarctation of a high-positioned right arch. Pediatr Radiol 37:584–586PubMedCrossRefGoogle Scholar
  20. 20.
    Pu WT, Chung T, Hoffer FA et al (1996) Diagnosis and management of agenesis of the right lung and left pulmonary artery sling. Am J Cardiol 78:723–727PubMedCrossRefGoogle Scholar
  21. 21.
    Wells TR, Gwinn JL, Landing BH et al (1988) Reconsideration of the anatomy of sling left pulmonary artery: the association of one form with bridging bronchus and imperforate anus. Anatomic and diagnostic aspects. J Pediatr Surg 23:892–898PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jonathan R. Dillman
    • 1
    Email author
  • Anil K. Attili
    • 3
  • Prachi P. Agarwal
    • 1
  • Adam L. Dorfman
    • 1
    • 2
  • Ramiro J. Hernandez
    • 1
  • Peter J. Strouse
    • 1
  1. 1.Department of Radiology, Section of Pediatric RadiologyUniversity of Michigan Health System, C.S. Mott Children’s HospitalAnn ArborUSA
  2. 2.Department of Pediatrics and Communicable Diseases, Division of Pediatric CardiologyUniversity of Michigan Health System, C.S. Mott Children’s HospitalAnn ArborUSA
  3. 3.Department of RadiologyUniversity of Kentucky College of MedicineLexingtonUSA

Personalised recommendations