When You See a Sling, Look for a Ring!

Abstract

Whereas the association of a pulmonary artery sling with complete tracheal rings (the so-called “sling-ring complex”) has been amply described, the usual clinical presentation is in childhood with acute respiratory distress resulting from airway compression. As one of few available reports of this association presenting in adulthood, we present the case of a 30-year-old woman with a large lung abscess and a history of asthma who was found on imaging and bronchoscopy to have this constellation of pulmonary artery sling with complete tracheal rings, the latter called a “stovepipe trachea.” Although we are unaware of a prior association with recurrent or severe infection, we speculate that the complete tracheal rings may have contributed to impaired cough, thereby predisposing to her large and initially refractory lung abscess. Clinicians should recognize this clinical association and the spectrum of other associated congenital anomalies.