Bronchial Arteries – A practical approach for the general radiologist

Congress:

ESTI 2019

Poster Number:

P-0103

Type:

Educational Poster

Keywords:

Thorax, Anatomy, Vascular, CT-Angiography, Fluoroscopy, Catheter arteriography, Embolisation, Normal variants, Diagnostic procedure, Pathology, Education and training, Hyperplasia / Hypertrophy

Authors:

J. M. Almeida¹, J. M. Veiga¹, C. A. S. Ruano¹, C. Leal², O. Fernandes¹, L. Figueiredo²; ¹Lisbon/PT, ²Lisboa/PT

DOI:

10.26044/esti2019/P-0103

DOI-Link:

https://dx.doi.org/10.26044/esti2019/P-0103

Fig. 2: Schematic picture representing most common variations of bronchial arteries.

Fig. 3: MDCT showing right and left bronchial arteries (axial and MPR).

Fig. 4: How to recognize normal and hypertrophied bronchial arteries in MDCT?

Fig. 5: TOF with pulmonary artery atresia with MAPCAs

Learning objectives

Review the normal anatomy, variants and function of the bronchial artery system. Describe and illustrate diseases associated with bronchial artery hypertrophy. Discuss the role and indications of bronchial artery embolization in the management of hemoptysis.

Background

The lungs are supplied by a dual circulatory system – pulmonary and bronchial. The pulmonary arteries supply deoxygenated blood to the lungs, being essential in the gas exchange. The bronchial arteries have a supportive role, providing oxygenated blood (1% of cardiac output) to the bronchial wall, large blood vessels, lymph nodes and pleura. [1] Both systems are connected through distal microvascular anastomoses. Some diseases affecting the pulmonary arterial system may cause secondary/compensatory bronchial artery dilatation, increasing bronchial flow (up to 30% of cardiac output) with...

Imaging findings OR procedure details

BRONCHIAL ARTERIES – ANATOMY The bronchial arteries most commonly arise from the proximal descending thoracic aorta at the level of T5-T6 (orthotopic) near the level of the carina (Fig. 1), although they can be ectopic in 36%, originating elsewhere, such as from the aortic arch, subclavian artery, thyrocervical trunk and coronary arteries. [2] When originating from the descending aorta, right bronchial arteries frequently arise from the posteromedial wall, whereas left bronchial arteries originate frequently from the anterior or lateral aortic wall, both coursing behind the...

Conclusion

Radiologists must be aware of the normal anatomy of the bronchial arteries as well as its most common variants. They must recognize when they’re hypertrophied and be able to identify possible underlying diseases. Angio-CT plays a major role in the pre-embolization assessment of patients with hemoptysis.

References

[1] Bruzzi JF, Rémy-Jardin M, Delhaye D, Teisseire A, Khalil C, Rémy J. - Multi–detector row CT of hemoptysis. - Radio-Graphics 2006;26(1):3–22 [2] Tanomkiat W, Tanisaro K. Radiographic relationship of the origin of the bronchial arteries to the left main bronchus. J Thorac Imaging 2003;18(1):27–33. [3] Morita Y, Takase K, Ichikawa H, Yamada T, Sato A, Higano S, Takahashi S - Bronchial artery anatomy: preoperative 3D simulation with multidetector CT. – Radiology. 2010 Jun;255(3):934-43. [4] Cauldwell EW, Siekert RG, et al. The bronchial arteries: an...