Current Thoracic Surgery

Pulmonary sling (PS) syndrome is a rare congenital vascular anomaly characterized by the anomalous origin of the left pulmonary artery (LPA) from the right pulmonary artery (RPA). While it typically presents in infancy with severe respiratory distress, its diagnosis in adulthood is exceedingly rare and often incidental. A 33-year-old male presented with acute, severe right-sided pleuritic chest pain. Initial suspicion was pulmonary embolism (PE); however, laboratory markers (D-dimer, troponin) were normal. Pulmonary CT angiography ruled out PE but revealed an incidental pulmonary sling, where the LPA originated from the RPA and coursed between the trachea and esophagus. A 10 mm pleural effusion was noted. The patient was diagnosed with idiopathic pleurisy, treated with anti-inflammatory agents, and symptoms resolved. This case underscores the possibility of PS remaining asymptomatic until the fourth decade of life. Clinicians should be aware of such vascular variants, as they may have significant implications for airway management and thoracic surgery.