Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System

Retrotracheal Pulmonary Arteries and Anomalous Origin of Left Pulmonary Artery.

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

A: ALPA= Anomalous (retrotracheal) left pulmonary artery; DA= ductus arteriosus; PT= pulmonary trunk; RPA= right pulmonary artery.

B: Diagram of tracheobronchial tree and pulmonary arterial system. In this case, there is no anomaly of tracheal bifurcation. The left pulmonary artery can be seen to arise from the right pulmonary artery. At the angle of the right main bronchus and the trachea, the anomalous left pulmonary curves posteriorly and upward the left side. In this position it can cause and obstruction of the airway. DA= Ductus arteriosus; EB= eparterial bronchus; HB, hyparterial bronchns; LB= left bronchus; LPA= anomalous left pulmonary artery; PT= pulmonary trunk; RPA= right pulmonary artery; T= trachea

C: The eparterial bronchus arises from the trachea. Below the anomalous eparterial bronchus, the trachea is hypoplastic. The hypoplastic trachea divides into the left main bronchus and the right hyparterial bronchus. The pulmonary artery does not give rise to the left pulmonary artery but, rather, continues to the right as the right pulmonary artery. Near the usual origin of the left pulmonary is only the insertion of the ligamentum arteriosum. When the right pulmonary artery reaches the the right side it gives rise to the anomalous left pulmonary artery and to branches which supply the right lung. The left pulmonary artery curves to the left, posteriorly around the hypoplastic trachea, causing compression of the airway between the eparterial bronchus and the bifurcation of the trachea. Labels and their designation are given above.

redrawn from Jue, Raghib, Amplatz, Adams,Jr. and Edwards, 1965.

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