Bronchial arteriography.

Abstract

The true functions of the systemic circulation of the lung in the living patient have been relatively neglected. To evaluate the role of this circulation in health and disease we have initiated an attempt to visualize experimentally the bronchial arteries and other components of this second circulatory system. Optimum visualization of the bronchial arteries on the roentgenogram is accomplished by retrograde femoral arterial catheterization, with placement of the catheter tip within the aorta just distal to the origin of the left subclavian artery. Fifty milliliters of high contrast radiopaque medium is injected and filming is begun at the start of injection. The normal variations in the origin of the bronchial arteries may be numerous. They may arise from the anterior aspect of the thoracic aorta at the level of the upper intercostals or as branches from any of the upper intercostal arteries. At times, the right bronchial artery may spring from the upper left bronchial vessel. Each side may have one or two arteries supplying its bronchial tree. The bronchi may be supplied partially by small arterial twigs from the internal mammary, pericardial, phrenic, or left subclavian arteries. The normal bronchial artery is minute, coursing anteriorly from its origin toward the carina and then peripherally, lying adjacent to the posterior aspect of the bronchus. As the artery approaches the periphery it forms a plexus around the bronchus and can normally be followed anatomically as far as the small bronchiole. Figure 1 shows an angiogram, with an explanatory diagram, of a normal dog. The right bronchial artery (A) originates from the first right aortic intercostal artery, and lies superior and anterior to the bronchial tree. A small esophageal branch (B) is noted. At the level of the bronchus the artery divides into three small radicles. The left bronchial artery (C) is derived from the anterolateral aspect of the descending aorta just below the level of the second aortic intercostal arteries (D). It continues anteriorly, giving rise to three branches, one of which lies superior and anterior to the carina. The middle branch is directly anterior, and the inferior one goes anterior to and beneath the carina. Other variations are seen in Figure 2 in which a broncho-gram and a bronchial arteriogram were obtained simultaneously. Both the right and left bronchial arteries are derived from the descending aorta. The left branch originates above the first aortic intercostal artery and the right courses anteriorly from the aorta just below the second aortic intercostal. Note their approach and proximity to the bronchi. Pathological changes in the systemic vessels of the lung may result either from primary abnormalities or changes secondary to parenchymal or pulmonary arterial disease. Primary multiple saccular aneurysms of the bronchial arteries have been recorded in a patient with luetic arteritis(3).