Abstract
Thoracic vascular congenital anomalies are malformations with significant clinical implications. One of the rarest anomalies is the anomalous origin of the brachiocephalic trunk from the pulmonary trunk, often associated with serious complications such as pulmonary hypertension. Diagnosis is facilitated by advanced imaging techniques, including MRI and CT scans. We present a case of a premature newborn with congenital heart disease (hypoplastic right ventricle) who developed respiratory and septic complications. A CT angiography revealed a left innominate artery arising from the pulmonary trunk. Despite valvuloplasty and multidisciplinary management, the infant passed away at two and a half months due to multi-organ failure. Early diagnosis and interdisciplinary management, aided by advanced imaging techniques such as CT angiography, are crucial for improving outcomes in patients with complex congenital heart malformations.