Vertical vascular ring around right mainstem bronchus

An 18-year-old male patient was referred with an atypical form of vascular ring consisting of a right aortic arch, a right descending aorta, a persistent right ligamentum arteriosum, and a dilated right pulmonary artery in the setting of discontinuous pulmonary arteries with a single functional right lung. The initial presentation was that of pneumonia of the right lung and later evaluation revealed the right mainstem bronchus was squeezed between the descending aorta and the dilated right pulmonary artery. Surgical exploration disclosed the right-sided ligamentum arteriosum was running under the right mainstem bronchus and hereby was completing a vertical vascular ring. Decompression was achieved through surgical and bronchoscopic treatment.