Crossed pulmonary arteries (CPA) is an unusual malformation characterized by abnormal origination of the pulmonary arteries from the main pulmonary artery (MPA), which is usually associated with complex cardiac pathologies and chromosomal abnormalities. We report a case of crossed pulmonary artery (CPA) associated with tetralogy of Fallot (TOF), right aortic arch (RAA), and absence of ductus arteriosus. Sonographic findings, complicated malformations, genetic anomalies, differential diagnosis, and prognosis analysis are discussed. Although the isolated CPA is relatively asymptomatic, when it is accompanied by other cardiac anomalies, the prognosis needs to be reevaluated.