ElHassan et al. Journal of Medical Case Reports 2010, 4:284 http://www.jmedicalcasereports.com/content/4/1/284 It has been previously suggested that the persistence of the aortopulmonary collaterals as the sole source of blood supply to a lobar segment indicates that an intrauterine insult had occurred between weeks five and eight of gestation [13]. We postulate that a vascular injury occurring within this timeline caused an LPA thrombosis and a maturational arrest of the LPA and the left lung. Another possible explanation is that he had an abnor- mal left pulmonary vasculature and lung development, and a thrombosis developed later in gestation. The only identified risk factors for thrombosis in this patient are the maternal history of type 2 diabetes and two previous maternal miscarriages. Of interest, the CTA in this baby identified aortopulmonary collaterals as the primary blood supply to the left lung. Pulmonary artery thrombosis was first suspected on echocardiogram evaluation. Although cardiac catheteri- zation with contrast angiography may be the gold stan- dard for the diagnosis of arterial thrombosis, CTA is a reliable alternative modality for evaluation of LPA thrombosis [4]. Treatment of neonatal spontaneous arterial thrombo- sis is controversial. An expert panel on the management of arterial thromboembolic events in neonates recom- mended that therapy should be individualized based on the extent of thrombosis and the urgency of the clinical situation [11]. Because this patient was stable after ECMO, no further anticoagulant therapy was given. Conclusion In conclusion, this is the first reported case of an intrau- terine LPA thrombosis and subsequent pulmonary hypoplasia in a live neonate. This article suggests that a possible vascular injury in the early weeks of gestation is an underlying etiology for such clinical presentation. Consent Written informed consent was obtained from the par- ents of this patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1Department of Pediatrics, Neonatology, University of Arkansas for Medical Sciences, College of Medicine, Arkansas Children’s Hospital, 1 Children’s Way, Slot 512-5, Little Rock, AR 72202-3591, USA. 2Department of Pediatrics, Cardiology, University of Arkansas for Medical Sciences, College of Medicine, Arkansas Children’s Hospital, 1 Children’s Way, Slot 836, Little Rock, AR 72202, USA. 3Department of Radiology, Fellowship Director, Pediatric Radiology, University of Arkansas for Medical Sciences, College of Medicine, Arkansas Children’s Hospital, 1 Children’s Way, Little Rock, AR 72202, USA. Page 5 of 5 Authors’ contributions NEH, CS, RS, STB, and JSS all participated in interpretation, intellectual content, and drafting of the manuscript. All authors have read and approved the manuscript. Competing interests The authors declare that they have no competing interests. Received: 19 November 2009 Accepted: 23 August 2010 Published: 23 August 2010 References 1. Kenny D, Tsai-Goodman B: Neonatal arterial thrombus mimicking congenital heart disease. Arch Dis Child Fetal Neonatal Ed 2007, 92:F59-F61. 2. Greenway A, Massicotte MP, Monagle O: Neonatal thrombosis and its treatment. Blood Rev 2004, 18:75-84. 3. Aslam M, Gugleitti D, Hansen AR: Neonatal arterial thrombosis at birth: case report and literature review. Am J Perinatol 2008, 25:347-352. 4. Sawyer T, Antle A, Studer M, Thompson M, Perry S, Mahnke CB: Neonatal pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn. Pediatr Cardiol 2009, 30:520-522. 5. 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