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 authors discuss methods of echocardiographic diagnosis of the pulmonary sling with stenosis and hypoplasia of the left pulmonary artery and patent arterial duct with massive left - to - right shunt , based on a case of the newborn with resistant to treatment heart failure , with initial diagnosis of patent ductus arteriosus , referred to surgical treatment . 
 the optimal echocardiographic views permitting establish diagnosis of the pulmonary sling were suggested . 
 the special attention was paid to high parasternal and suprasternal views visualizing vessels of the upper mediastinum as well as characteristic differences between the normal and pathologic picture . 
 the typical features of the echocardiogram suggesting pulmonary sling , like the lack of the left pulmonary artery in its expected position , and the abnormal branching pattern of the right pulmonary artery were indicated . 
 the greatest diagnostic difficulties in visualization of the abnormal route of the left pulmonary artery were related to the presence of air - containing tissues , like lungs and central airways between the ultrasound probe and area of interest . 
 the other was the masking influence of the large patent arterial duct , that may mimic the left pulmonary artery arising from the pulmonary trunk . 
 the other entities requiring differentiation with sling , like aplasia of the left lung , the direct or indirect aortic origin of the left pulmonary artery , were discussed . 
 the role of other visualization technics , like computed 3d tomography , and magnetic nuclear resonance , as well as direct visualization of central airways with bronchoscopy in establishing precise diagnosis were stressed . 
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