Crossed Pulmonary Arteries: A Literature Review

Crossed pulmonary artery (CPA) is a rare congenital malformation with only about 100 cases reported worldwide. It is often an incidental finding on cardiac imaging with symptoms rarely attributed to this anomaly. Sometimes, it can result in difficulties during catheterization and surgical procedures. Thus, it is necessary to diagnose CPA preoperatively to reduce misadventures. CPA is primarily diagnosed by computerized tomography angiography (CT angio) and missing it during echocardiography is common, even when an accurate diagnosis is possible by echocardiography alone. Echocardiography can also differentiate it from other causes of nonvisualization of pulmonary artery bifurcation. Recent studies suggest that CPA is not as rare as previously described. With increased utilization of CT angio, more cases of CPA are being picked up, which were not noted earlier on echocardiography. Missing CPA on echocardiography is attributed mainly to the lack of awareness regarding this condition among echocardiographers. Raising awareness can avoid missed diagnoses and aid in planning the interventional and surgical procedures.