MDCT assesses a lot of congenital pulmonary arterial anomalies, such as atresia, stenosis, hypoplasia, and dilatation in addition to the postoperative appearance of the pulmonary arterial tree. These anomalies may be isolated or associated with other cardiovascular anomalies. CT helps assessment of the central and peripheral pulmonary arteries. In CT study we can detect the presence, patency, confluence, or caliber of the pulmonary arteries which must be diagnosed before definitive surgery as this information can affect surgical decision-making . Pre- and postoperative assessment of the pulmonary artery can be accurately and non-invasively detected with CT. Reformatted images can be used to establish accurate measurements of the luminal diameter of the pulmonary artery that correlate highly with findings at cardiac catheterization . Echocardiography and cardiac catheterization consider the main modalities in the diagnostic process of complex congenital heart diseases (CHD). However, its performance may be lacking in terms of visualization of extracardiac structures such as airways abnormalities. CT is mandatory to diagnose the type of anomaly and the relationship between the trachea and the esophagus, which are surrounded by vascular structures. Three-dimensional (3D) reconstructions of trachea and vessels permit an understanding of their reciprocal relationship allowing the surgeon to plan the surgical strategy. This kind of analysis should be performed before planning surgical interventions . Tracheal stenosis may not be limited to the aberrant vascular compression but due to congenital stenosis. The anesthesiologist should be aware of this point as it may pose risk during the ETT introduction. So, CT scan is not only important for surgical planning but also to alert anesthesiologists about potential complications caused by airway anomalies. In our study, the most common pulmonary artery anomalies were atresia, stenosis, and hypoplasia. Liu et al.  stated that pulmonary atresia is a rare anomaly with a prevalence of approximately 1 in 200,000, but in our study, it was the most common anomaly with 16 cases; it may be because our hospital is a tertiary referral. Leonard et al.  classified pulmonary atresia into three types, pulmonary atresia with the intact interventricular septum, pulmonary atresia with VSD, and complex pulmonary atresia. Pulmonary atresia with a ventricular septal defect is known as a group of congenital cardiovascular anomalies in which there is complete disruption between the right ventricular outflow tract and the pulmonary trunk. These patients may have atresia of part or all of the central pulmonary arteries . In our study, there are 11 cases of pulmonary atresia with VSD, 4 cases of pulmonary atresia with the intact interventricular septum, and 1 case with complex pulmonary atresia, and it agrees with Leonard et al. . In this study, atresia of MPA as well as RPA and LPA in 10 cases, atresia of MPA and RPA in 3 cases, and atresia of MPA and LPA in 3 cases. Associated congenital anomalies more with LPA atresia such as tetralogy of Fallot and this agree with Ryu et al.  that stated right pulmonary artery atresia usually occurs in the absence of other congenital abnormalities, while left pulmonary artery atresia often occurs with other congenital cardiac conditions, such as of tetralogy of Fallot. In our study, the most common associated finding with pulmonary atresia is PDA, VSD, and tetralogy of Fallot, and this is in agreement with Harikrishnan et al. . In Fallot tetralogy with severe infundibular stenosis, there may be complete obstruction of pulmonary blood flow. This is known as Fallot tetralogy with pulmonary atresia and considers a specific type of pulmonary atresia with VSD. Complete disconnection of the right ventricle from the pulmonary arteries and the obligatory presence of extracardiac sources of pulmonary arterial blood flow differentiate pulmonary atresia with VSD type from the Fallot tetralogy . Pulmonary artery stenosis classified into several types: type I, involving main pulmonary artery; type II, involving bifurcation; type III, multiple peripheral stenoses; and type IV, central and peripheral stenosis . In our study, stenosis of the pulmonary artery in 13 cases (25%), 6 cases type I, 4 cases type II, 3 cases type III, and no cases type IV, the most common type is type 1 (6 cases), and this agrees with Hirsig et al. . Although pulmonary stenosis may be an isolated finding, it is often syndromic and/or associated with other cardiac abnormalities . In our study, pulmonary stenosis was common apart of Fallot tetralogy (7 cases), and this agrees with Helmut et al. , or syndromic such as in our study arterial tortuosity syndrome (ATS) that is proved by gene testing and it is in agreement with Callewaert et al.  and Bhat et al.  that stated that it is extremely rare autosomal recessive disease caused by alterations in the SLC2A10 gene. The most common presentation in all children is tortuous artery; characteristic angiographic feature showed pulmonary stenosis, significant tortuosity of the great vessels such as aorta, changes in the caliber and significant areas of widening and narrowing are seen in medium-sized arteries such as common carotid and subclavian arteries which also involve the abdominal vasculature, e.g., superior mesenteric artery, and all is giving a clue to the diagnosis of arterial tortuosity syndrome with other radiological and clinical finding. Hypoplasia of the pulmonary artery can be diagnosed when narrowing was diffuse involving a long segment of the artery . In 10 cases, there was hypoplasia of the pulmonary artery. Pulmonary artery hypoplasia is a rare congenital anomaly. It is frequently associated with other congenital anomalies, such as tetralogy of Fallot, a ventricular septal defect, transposition of great vessels, and aortic arch anomalies . In our study, there were 8 cases pulmonary artery dilatation, 6 cases dilated MPA and left pulmonary artery and 2 dilated MPA; all are associated with other multiple cardiac anomalies and it differs from idiopathic dilatation of the pulmonary trunk that it is a rare congenital anomaly comprising of pulmonary trunk enlargement with or without dilatation of the right and left pulmonary arteries. For this diagnosis, exclusion of pulmonary and cardiac diseases (mainly pulmonary valve stenosis) and confirmation of the presence of normal pressures in the right ventricle and pulmonary artery is required . A group of anomalies that affects both the pulmonary artery and aorta are called aorto-pulmonary anomalies; they include truncus arteriosus, patent ductus arteriosus, and transposition of great vessels. In our study, there were 2 cases of truncus arteriosus and 27 cases patent ductus arteriosus. Truncus arteriosus accounts for 1% of congenital cardiac disease and is defined by a single great artery supplying the systemic, coronary, and pulmonary blood flow. The single truncal valve may have two to five leaflets, which may be stenotic or insufficient. An atretic pulmonary valve and a ventricular septal defect may also be present. Truncus arteriosus is rare with an incidence of in 1 in 10,000 births . The classification of arteriosus devised by Van Praagh  are type A1: aorta and main pulmonary artery share a common arterial trunk, type A2: separate origins of the branch pulmonary arteries from the left and right lateral aspects of the common trunk, type A3: origin of one branch pulmonary artery (usually the right) from the common trunk, with other lung supplied either by collaterals or a pulmonary artery arising from the aortic arch, type A4: coexistence of an interrupted aortic arch. According to this classification, our two cases are type 1. In our study, 5 cases have aberrant left pulmonary artery and 3 cases have aberrant right pulmonary artery. Aberrant right pulmonary artery is associated with aortic anomalies, aberrant left pulmonary artery is associated with anomalies subclavian arteries, and these agree with Kutsche et al.  who stated that aberrant pulmonary artery is anomalous origin of a branch pulmonary artery from ascending aorta and it is 0.3% of congenital heart disease, aberrant left pulmonary artery may be associated with tetralogy of Fallot, and anomalous subclavian arteries. On the contrary, patent ductus arteriosus and aortic anomalies may be associated with the aberrant right pulmonary artery. Left pulmonary artery sling represents an anatomical variant characterized by the left pulmonary artery arising from the right pulmonary artery and passing above the right main bronchus and in between the trachea and esophagus to reach the left lung. It may lead to compression and focal stenosis of the trachea . In our study, one case of left pulmonary artery sling is detected. In our study, 2 cases of the aberrant left pulmonary artery with airway compression but one of the causes is an aberrant left pulmonary artery and the other is due to congenital stenosis so that CT scan is not only important for surgical planning but also to alert anesthesiologists about potential complications caused by the airway anomalies. Complications following cardiothoracic surgery are responsible for increased morbidity and mortality. Vascular complications in particular are significant contributors to poor patient outcomes due to either hemorrhage or thrombosis and ischemia. Evaluation of vascular complications in the postoperative patient requires a rapid and reliable imaging approach. Vascular complications after cardiothoracic surgery include pulmonary artery thrombosis, pseudoaneurysm, pulmonary vein thrombosis, vascular fistulas, stenosis, and infarction. MDCT is often the imaging modality of choice to visualize the entire cardiothoracic vasculature, airways, lung parenchyma, and mediastinum . In our study, patients with pulmonary and tricuspid atresia, post-Glenn surgery, on aspirin, developed marked RV hypertrophy with a fistula between RV cavity and right coronary artery. Another fistula between the RV cavity and the left anterior descending artery. The RV-RCA fistula shows focal stenosis whereas the RV-LAD fistula shows focal aneurysmal dilatation. MDCT is a rapid and non-invasive imaging study used for the diagnosis of pediatric thoracic vasculature diseases as an alternative to conventional angiography. Three-dimensional (3D) images allow accurate delineation of vascular anomalies that can be used as a vascular road map by surgeons.