Bronchial and Nonbronchial Systemic Arteries in Patients with Hemoptysis: Depiction on MDCT Angiography
Myung Jin Chung1,
Ju Hyun Lee1,
Kyung Soo Lee1,
Young Cheol Yoon1,
O Jung Kwon2 and
Tae Sung Kim1
1 Department of Radiology, Samsung Medical Center, 50, Ilwon-Dong, Kangnam-Ku,
Seoul 135-710, Korea.
2 Division of Pulmonary and Critical Care Medicine, Department of Medicine,
Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
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Fig. 1A —Enlarged right intercostobronchial trunk in 38-year-old man with
multi-drug-resistant pulmonary tuberculosis. Lung window coronal
reconstruction image (2.0-mm thickness) shows multiple thin-walled cavities in
right lung and bronchiectasis (arrows) in right upper lobe.
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Fig. 1B —Enlarged right intercostobronchial trunk in 38-year-old man with
multi-drug-resistant pulmonary tuberculosis. Selective right bronchial
angiogram shows enlarged right intercostobrachial trunk. Hypertrophied
inferior branch (arrows, right bronchial artery) supplies right
bronchial tree.
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Fig. 1C —Enlarged right intercostobronchial trunk in 38-year-old man with
multi-drug-resistant pulmonary tuberculosis. Mediastinal window transaxial CT
scan (1.25-mm thickness) obtained at level of main bronchi shows enlarged
right bronchial artery arising from aorta (arrow). Also note its
branches (arrowheads) along right airway with dotlike
appearances.
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Fig. 1D —Enlarged right intercostobronchial trunk in 38-year-old man with
multi-drug-resistant pulmonary tuberculosis. Mediastinal window oblique
coronal image (2.0-mm collimation) shows right intercostobronchial trunk
(arrow) and intercostal artery (arrowhead) arising from
aorta.
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Fig. 1E —Enlarged right intercostobronchial trunk in 38-year-old man with
multi-drug-resistant pulmonary tuberculosis. Volume-rendering image clearly
shows right intercostobronchial trunk (arrow) and intercostal
arteries (arrowheads) arising from aorta.
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Fig. 2A —Double left bronchial arteries in 51-year-old man with
bronchiectasis. Lung window coronal reconstruction image (2.0-mm collimation)
shows bronchiectasis and mucus plugging (arrows) in both lower lobes.
Also note findings of bronchiolitis with small nodules and tree-in-bud pattern
(arrowheads).
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Fig. 2B —Double left bronchial arteries in 51-year-old man with
bronchiectasis. Selective bronchial arteriograms obtained at levels of T5
(B) and T8 (C) show hypertrophied left bronchial arteries
supplying both bronchiectatic lower lobes. Upper left bronchial artery arises
as common trunk (arrow in B indicates catheter tip located in
common trunk) with right bronchial artery from aorta. Selective lower left
bronchial arteriogram shows arterial supply (arrows, C) to
bronchiectatic left lower lobe and retrograde filling of hypertrophied
esophageal branch of right inferior phrenic artery (arrowhead,
C) via collateral pathways from left bronchial artery. Patient
underwent coil embolization of right bronchial and right inferior phrenic
arteries.
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Fig. 2C —Double left bronchial arteries in 51-year-old man with
bronchiectasis. Selective bronchial arteriograms obtained at levels of T5
(B) and T8 (C) show hypertrophied left bronchial arteries
supplying both bronchiectatic lower lobes. Upper left bronchial artery arises
as common trunk (arrow in B indicates catheter tip located in
common trunk) with right bronchial artery from aorta. Selective lower left
bronchial arteriogram shows arterial supply (arrows, C) to
bronchiectatic left lower lobe and retrograde filling of hypertrophied
esophageal branch of right inferior phrenic artery (arrowhead,
C) via collateral pathways from left bronchial artery. Patient
underwent coil embolization of right bronchial and right inferior phrenic
arteries.
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Fig. 2D —Double left bronchial arteries in 51-year-old man with
bronchiectasis. Volume-rendering image shows clearly hypertrophied upper
(arrows) and lower (arrowheads) left bronchial arteries.
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Fig. 3A —Hypertrophied ectopic right bronchial artery in 51-year-old woman
with bronchiectasis in both lungs. Lung window coronal reconstruction CT image
(2.0-mm collimation) shows extensive bilateral bronchiectasis and
bronchiolitis (small nodules and tree-in-bud pattern) in both lungs.
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Fig. 3B —Hypertrophied ectopic right bronchial artery in 51-year-old woman
with bronchiectasis in both lungs. Selective right bronchial arteriography
image shows enlarged and tortuous right bronchial artery
(arrows).
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Fig. 3C —Hypertrophied ectopic right bronchial artery in 51-year-old woman
with bronchiectasis in both lungs. Mediastinal window oblique coronal
reconstruction image (2.0-mm thickness) shows ectopic right bronchial artery
(arrowhead), which is 3.2 mm in diameter, arising from right internal
mammary artery (arrow). Selective right internal mammary angiogram
was not obtained because aortogram (not shown) failed to show this vessel.
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Fig. 3D —Hypertrophied ectopic right bronchial artery in 51-year-old woman
with bronchiectasis in both lungs. Volume-rendering image shows right
bronchial artery (arrowheads) arising from right internal mammary
artery (arrows).
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Fig. 4A —Common trunk of lower right bronchial artery in 55-year-old woman
with bronchiectasis. Selective bronchial arteriograms obtained at levels of T5
(A) and T6 (B) show hypertrophied right bronchial arteries;
upper right bronchial artery arises as intercostobronchial trunk
(arrow, A) and lower artery (arrow, B) arises
as common trunk with enlarged left bronchial artery (arrowheads,
B).
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Fig. 4B —Common trunk of lower right bronchial artery in 55-year-old woman
with bronchiectasis. Selective bronchial arteriograms obtained at levels of T5
(A) and T6 (B) show hypertrophied right bronchial arteries;
upper right bronchial artery arises as intercostobronchial trunk
(arrow, A) and lower artery (arrow, B) arises
as common trunk with enlarged left bronchial artery (arrowheads,
B).
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Fig. 4C —Common trunk of lower right bronchial artery in 55-year-old woman
with bronchiectasis. Volume-rendering image shows clearly common trunk
(arrow) of lower right bronchial artery and left bronchial artery.
Also note hypertrophied upper right bronchial artery
(arrowheads).
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Fig. 5A —Left bronchial artery aneurysm in 31-year-old man with chronic
destructive tuberculosis in both upper lobes. Patient had previously undergone
right bronchial artery embolization. Mediastinal window transaxial CT scan
(1.25-mm thickness) obtained at level of azygos arch shows aneurysmal
dilatation (solid arrow) of left bronchial artery. Also note enlarged
branches of right bronchial artery (arrowheads) and calcified lymph
nodes (open arrows) in right lower paratracheal area.
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Fig. 5B —Left bronchial artery aneurysm in 31-year-old man with chronic
destructive tuberculosis in both upper lobes. Patient had previously undergone
right bronchial artery embolization. Mediastinal window coronal reconstruction
image (2.0-mm thickness) shows aneurysmal dilatation (arrow) in left
bronchial artery, which arises from aortic arch (arrowhead).
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Fig. 5C —Left bronchial artery aneurysm in 31-year-old man with chronic
destructive tuberculosis in both upper lobes. Patient had previously undergone
right bronchial artery embolization. Volume-rendering image shows aneurysm
(arrow) and hypertrophied left bronchial artery (arrowheads)
distal to it.
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Fig. 6A —Nonbronchial systemic arterial supply in 60-year-old woman with
bronchiectasis in left lower lobe. Selective arteriogram shows enlarged left
inferior phrenic artery (arrows) supplying bronchiectatic left lower
lobes with fistulous connection to left pulmonary artery
(arrowheads).
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Fig. 6B —Nonbronchial systemic arterial supply in 60-year-old woman with
bronchiectasis in left lower lobe. Mediastinal window oblique coronal
reconstruction image (2.0-mm thickness) shows hypertrophied left inferior
phrenic artery (arrows) heading toward left lower lobe.
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Fig. 6C —Nonbronchial systemic arterial supply in 60-year-old woman with
bronchiectasis in left lower lobe. Volume-rendering image shows both
hypertrophied left inferior phrenic artery (arrows) and left
pulmonary artery (arrowheads) with fistulous connection.
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Fig. 7A —Nonbronchial systemic arterial supply from left intercostal artery
in 45-year-old woman with aspergillomas. Mediastinal window transaxial CT scan
(1.25-mm collimation) obtained at level of great vessels shows two
low-attenuation aspergillomas in cavities in both upper lobes. Also note
hypertrophied left intercostal artery branches (arrows) located in
thickened pleura.
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Fig. 7B —Nonbronchial systemic arterial supply from left intercostal artery
in 45-year-old woman with aspergillomas. Mediastinal window coronal
reconstruction image (2.0-mm collimation) shows enlarged left intercostal
artery branches (arrows) heading toward aspergilloma cavity.
Aspergilloma contains calcification (arrowhead) within it.
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Fig. 7C —Nonbronchial systemic arterial supply from left intercostal artery
in 45-year-old woman with aspergillomas. Volume-rendering image shows
hypertrophied left intercostal artery (arrows) arising from aorta,
heading toward aspergilloma cavity (arrowheads).
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Copyright © 2006 by the American Roentgen Ray Society.
