To assess the diagnostic value of transthoracic echocardiography for congenital right pulmonary artery anomalies in children, and to summarise the reasons for their missed diagnosis or misdiagnosis.

Five children with right pulmonary artery anomalies who underwent transthoracic echocardiography at the Department of Ultrasound of Shanxi Children's Hospital from December 2020 to March 2023 were included in this study. The anomalies of the five children were confirmed by CT angiography (CTA) examination or surgery. The surgical diagnoses, ultrasound images, and diagnostic results were then analysed.

Among the five cases of right pulmonary artery anomalies, one was identified as right pulmonary artery agenesis, while the remaining four were identified as right pulmonary artery anomalies originating from the ascending aorta (AORPA). Out of the five cases of right pulmonary artery anomalies, right pulmonary artery anomaly was misdiagnosed as coarse arterial ductus arteriosus by initial ultrasound in one case AORPA and aortopulmonary artery septal defect were missed in two cases. simple AORPA was correctly diagnosed by initial ultrasound in two cases, and combined intracardiac malformations were correctly diagnosed by preoperative echocardiography combined with CTA in three cases.

Transthoracic echocardiography can more accurately diagnose right pulmonary artery anomalies and the combined intracardiac malformations. However, it is prone to missed diagnosis or misdiagnosis. Scanning in high parasternal aortic views and enhancing the understanding of the anomalies can help improve the diagnosis rate of right pulmonary artery anomalies by transthoracic echocardiography.