Late diagnosis of anomalous right pulmonary artery originated from ascending aorta: Associated with small pulmonary artery aneurysm

Anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) is an extremely rare congenital cardiac malformation, commonly observed early in life. Patients with AORPA usually present with nonspecific clinical symptoms, commonly associated with other congenital cardiac anomalies and some complications as pulmonary hypertension and heart failure. A high index of clinical suspicion and noninvasive diagnostic imaging studies play an important role in diagnosis and preventing high mortality rates. We report a case of anomalous origin of the right pulmonary artery from the ascending aorta in a 15-year-old girl that was diagnosed with severe pulmonary hypertension, pulmonary hemorrhage, and small pulmonary artery aneurysm. Clinical, radiographic imaging and other investigations’ findings are described. To the best of our knowledge, this is the first reported case of anomalous origin of the right pulmonary artery from the ascending aorta with large patent ductus arteriosus associated with a small pulmonary artery aneurysm.