Left Bronchial Artery Research Articles

Embolization and bleeding in patients with anticardiolipin antibodies

The patient, a 32-year-old male, was positive for anti-cardiolipin antibody syndrome and had a history of smoking for 15 years. He underwent “inferior vena cava filter implantation + catheter hemolysis” 10 years ago due to deep vein thrombosis of the right lower limb. After surgery, he continued to take farwarin and aspirin orally. Three years ago, due to thrombosis again, intravenous thrombolysis was performed in the lower extremity. After surgery, pharhualin was taken orally continuously. Massive hemoptysis occurred after intense exercise and eating spicy stimulating food 5 months ago. DSA showed abnormal bleeding in the right bronchial artery and right internal thoracic artery, so 300-500 um microsphere was used to embolize the peripheral artery. 350-560 um PVA granules embolized bronchial arteries; Three months ago, due to the recurrence of hemoptysis after oral administration of TCM blood-promoting drugs, angiography showed an increase in the number of responsible arteries, abnormal bleeding of the left bronchial artery and the right upper lobar bronchial artery of the lung segment, the formation of the middle and lower lobar bronchial artery of the right lung segment and the formation of collateral circulation of the right internal thoracic artery. Embolization of the above arteries was performed, and the patient recovered well after surgery and was discharged from hospital.

488. LEFT BRONCHIAL ARTERY IN ESOPHAGEAL SURGERY

Abstract Commonest cause of morbidity after esophagectomy is pulmonary. Tracheobronchial devascularization during surgery contributes to this morbidity and can potentially lead to mortality. This video shows that left bronchial arteries can be preserved like the right ones in an attempt to aid rapid recovery of patients. This is the link to the video. https://drive.google.com/file/d/11iWQ5KUTSoc9qCmViCUlGPF61iCvCnJk/view?usp=share_link.

Arterial blood vessels of the lung of the Russian hound breed dogs in the age aspect

Such a breed of dog as the Russian Hound is the most popular breed among hounds in Russia. The average weight is 25 -35 kg, and at the withers it reaches up to 65 cm, representatives of this breed live up to 14-16 years. They are easily trained and are ideal hunting companions for hare and fox, during which they often suffer injuries in the chest cavity, and veterinarians face the difficult task of providing surgical care to such patients. Knowledge of the anatomical and topographic features of the arterial bed of the lungs is necessary when providing surgical care. During the formation of the functional activity of the body, the change in the diameter of the arterial bed is of particular interest. The purpose of the study was to study the arterial bed of the lungs of the Russian Hound breed in the age aspect, to give the arteries a morphometric characteristic. Three age groups of dogs were selected for the study: newborn puppies, puppies at the age of nine months, and mature dogs. Fine anatomical preparation, vasorentgenography, morphometry was chosen as research methods. During the study, morphometric data of such vessels as: pulmonary trunk, right and left pulmonary arteries, right and left bronchial arteries were obtained.

Hemoptysis: unilateral pulmonary artery atresia? a case report

BackgroundAsymptomatic, isolated cases of unilateral pulmonary artery atresia may present in adulthood with symptoms such as recurrent respiratory infections, dyspnea, hemoptysis, and pulmonary hypertension. Unlike previously reported patients that underwent surgical management for this pathology, the patient in this report had no chronic history of recurrent respiratory infections, dyspnea, or pulmonary hypertension, making a diagnosis prior to extensive imaging difficult.Case presentationA 55-year-old male presented to our emergency department (ED) with a 3-day history of recurrent cough with 2–3 tablespoons of hemoptysis per episode, chills, and occasional wheezing. A computed tomography angiography (CTA) was performed, which identified a congenital absence of the left pulmonary artery and a right-sided aortic arch. Hypertrophied left intercostal and bronchial arteries were noted to be perfusing the left lung. V/Q scan confirmed a heterogeneous distribution of gas throughout both lung fields with 97% perfusion to the right lung, but no visualization of the left lung on the perfusion images. Given extensive collateral blood supply to the left lung, interventional radiology performed a GELFOAM® embolization of the hypertrophied left bronchial artery and two parasitized arteries from the left subclavian artery to minimize intra-operative blood loss. This was immediately followed by a left thoracotomy, pneumonectomy, intercostal muscle flap placement, and bronchoscopy. The procedure was 360 min long with a total of 1500 cc blood loss that was salvaged and re-infused. No additional blood products were administered. The patient remained intubated post-operatively and was transferred to the surgical intensive care unit. His postoperative course was complicated by troponin leak, rhabdomyolysis, delirium, and ileus, all of which resolved over time. He was discharged home on postoperative day seven and continues to do well one-year later.ConclusionsThe patient in this report presented with several episodes of isolated hemoptysis but unlike previously reported cases of unilateral pulmonary artery atresia, he had no history of recurrent respiratory infections, dyspnea, or pulmonary hypertension. Although unilateral pulmonary artery atresia is a rare diagnosis, in patients with unexplained, isolated hemoptysis, further examination of the vasculature may be warranted, and surgical management may be beneficial in appropriate, symptomatic patients.

A case of bronchial Dieulafoy disease and literature review

ObjectiveBronchial Dieulafoy's disease (BDD) is a rare disease that causes massive hemoptysis. This paper reports a case of BDD treated surgically. At the same time, we summarize the data of BDD patients reported in domestic and foreign literature to improve the understanding, diagnosis and treatment of this disease.MethodsA case of BDD with hemoptysis during bronchoscopy was reported. In addition, we searched for "bronchial Dieulafoy disease" through Pubmed, Web of Science, CNKI and Wanfang databases, covering the literature related to BDD that was definitely diagnosed or highly suspected from January 1995 to December 2021, and summarized the clinical characteristics, chest imaging, bronchoscopic manifestations, angiographic characteristics, pathological characteristics, treatment and outcome of patients.ResultsThe patient was a 68 year old male. Tracheoscopy revealed nodular and mass like changes in the basal segment of the left lower lobe, which appeared massive hemorrhage when touching the surface. The computed tomography angiophy of the bronchial artery confirmed that the branches of the left bronchial artery were tortuous and dilated, and then the left lower lobe of the lung was resected. During the operation, 3 thick tortuous nutrient artery vessels were sent out from the descending aorta, and 1 thick tortuous nutrient artery was sent out from the autonomic arch. All of them were ligated and cut. The pathology after the operation was in accordance with BDD; The patient did not have hemoptysis after discharge and is still under follow-up. The database identified 65 articles from January 1995 to December 2021. After removing repeated reports, meetings, incomplete information and nursing literature, 60 articles were included to report 88 cases of BDD. BDD can occur at all ages, with a male to female ratio of about 1.6:1. It mainly starts with hemoptysis, and can also be seen due to cough, infection, and respiratory failure; Inflammatory changes such as pulmonary patch shadow, exudation shadow and ground glass shadow of pulmonary hemorrhage were more common in chest imaging; The diagnosis of BDD is mainly based on the bronchoscopy, bronchial angiography and pathological findings of surgical or autopsy specimens. Bronchoscopic findings were mostly non pulsating, smooth nodular or mucosal processes. Bronchial angiography mainly showed tortuous dilatation of bronchial artery, and the lesions were mainly located in the right bronchus, more from the bronchial artery; Diagnosis depends on pathology, showing submucosal expansion of bronchus or abnormal artery rupture and bleeding; 54 cases underwent selective bronchial artery embolization, 39 cases underwent pulmonary lobectomy, 66 cases improved, and 10 cases died (all of them were caused by massive hemorrhage during bronchoscopic biopsy).ConclusionBDD is rare, but may cause fatal massive hemoptysis. Bronchial angiography is considered to be an effective method to diagnose BDD. Since pathological biopsy may lead to fatal bleeding, the necessity of pathological diagnosis remains controversial. Interventional and surgical treatment plays an important role in patients with cough accompanied by massive hemoptysis.

THE ROLE OF CHEST CT ANGIOGRAPHY AS A DIAGNOSTIC TOOL AND ROAD MAP FOR THE MANAGEMENT OF RASMUSSEN’S ANEURYSM: A CASE REPORT

Rasmussen’s aneurysm is a pulmonary artery pseudoaneurysm, secondary to the invasion of granular tissues to the pulmonary artery wall, causing massive hemoptysis. A 39-year-old male, with a history of pulmonary TB presented with massive hemoptysis, persistent cough, and dyspnea. Chest X-ray and Chest CT depicted active pulmonary tuberculosis and a co-infection with aspergillosis in the form of aspergilloma. Chest CT angiography (CTA) showed narrow-necked Rasmussen’s aneurysm with the feeding artery coming from the pulmonary artery of the apicoposterior segment and the systemic artery from the left thyrocervical trunk branch and left bronchial artery. Fluoroscopy-guided transarterial embolization with polyvinyl alcohol (PVA) and gel foam was performed from the left bronchial artery and thyrocervical trunk branch followed by transcatheter embolization with glue insertion via the pulmonary artery in the aneurysmal site. After the procedures the embolic agent completely filled the aneurysm and there were no complaints of hemoptysis during the follow-up. Appropriate chest CT angiography procedures can help diagnose Rasmussen’s aneurysm and become a road map for embolization. Transarterial catheter embolization from bronchial or non-bronchial systemic artery and pulmonary artery can be used as the treatment modality of choice for Rasmussen’s aneurysm in pulmonary tuberculosis with aspergillosis co-infection in the form of aspergilloma.

909: MULTIPLE ARTERIAL COLLATERALS TO AN ASPERGILLOMA CAUSING RECURRENT HEMOPTYSIS

Introduction: Aspergillus is a fungus that is ubiquitous in the environment and causes various clinical syndromes depending on host characteristics. The spectrum of disease affects 3 million people worldwide and ranges from an asymptomatic fungal ball to lung destruction. We present a patient with a history of tuberculosis and pulmonary aspergilloma which parasitized multiple arterial sources including the bronchial artery, internal mammary artery, and several subclavian artery branches with venous fistulization. Description: A 79-year-old man presented with 6 months of daily hemoptysis. His past medical history was significant for diabetes mellitus, severe centrilobular emphysema, mycobacterium avium complex infection, and previously treated tuberculosis. A computed tomography scan of the chest demonstrated a left upper lobe (LUL) mass with cavitation. He underwent flexible bronchoscopy with bronchoalveolar lavage and endobronchial biopsy of the LUL. The fungal culture grew Aspergillus fumigatus which correlated with the biopsy which revealed a conglomerate of septate hyphae consistent with an aspergilloma. He was referred for bronchial artery angiogram with embolization. During the procedure multiple arterial feeders to the aspergilloma were identified. This included the left bronchial artery, left internal mammary artery, left superior thoracic artery, left thoraco-acromial artery and left lateral thoracic artery. Each of these arteries supplying the aspergilloma demonstrated the added complexity of venous fistulization. Due to the presence of venous fistulas, embolization was performed using n-butyl cyanoacrylate with lipiodol. Considering the patient’s clinical stability, length of procedure and radiation time and contrast administered, as well as the absence of active bleeding during the procedure, the left internal mammary artery and left thoraco-acromial artery were not embolized with the intent of a follow-up procedure. Discussion: Chronic pulmonary aspergillosis can cause life-threatening hemoptysis when arterial feeders develop to supply an aspergilloma. First line treatment options include bronchial arterial embolization. This case highlights the unusual presentation of an aspergilloma that both parasitized numerous systemic arteries while forming venous fistulas, a rare phenomenon.

Endovascular management of hemoptysis in a known case of tetralogy of fallot and tuberculosis complicated with aspergilloma: a case report

BackgroundHemoptysis is a life-threatening complication due to bleeding either from hypertrophied bronchial arteries or enlarged non-bronchial systemic collaterals, having multiple etiologies. Bronchial artery embolization (BAE) is a minimally invasive modality of management that can effectively manage moderate-to-severe hemoptysis.Case presentationWe report the case of a 25-year-old female with moderate-to-severe hemoptysis. There was prior history of tuberculosis and treatment with anti-tubercular therapy 6 months back. There was also a background of tetralogy of Fallot(TOF) with symptoms of chronic breathlessness and palpitations. Imaging evaluation with X-ray and HRCT thorax revealed a cavity in the left upper lobe with dependent soft tissue, implying a diagnosis of aspergilloma in an old tubercular cavity. TOF and right-sided aortic arch were noted. CT bronchial angiography showed dilated and tortuous left bronchial artery, as well as non-bronchial systemic collaterals from the ipsilateral internal mammary artery. Endovascular management was achieved by super-selective catheterization and embolization of the involved branch of the left bronchial artery and selective embolization of non-bronchial systemic collaterals from the ipsilateral internal mammary artery.ConclusionsBAE has a high clinical success rate and is recommended as first-line therapy in the management of massive hemoptysis. The CT pulmonary angiography, as well as the pre-embolization angiogram, is very important to detect the source of hemoptysis from the non-bronchial systemic circulation, increasing the success rate and decreasing the incidence of recurrence. BAE is effective even in presence of underlying vascular anomalies such as Fallot of Tetralogy.

Rare Cases of Bronchial Aneurysm and Comparison of Interventional Embolization in the Treatment of True Bronchial Aneurysm and Pseudobronchial Aneurysm.

BackgroundBronchial artery aneurysm (BAA) is a rare disease. Rupture of BAA can lead to life-threatening hemoptysis, and once diagnosed, treatment is needed regardless of symptoms. Transcatheter artery embolization is the first choice of treatment because it is minimally invasive and effective. This study aimed to retrospectively compare the embolization treatment of a case of true BAA and that of a pseudobranchial aneurysm and explore the choice of embolization method for BAA with short neck or no neck.Materials and MethodsEmbolization treatment and imaging characteristics of one case of true BAA and one case of pseudobronchial aneurysm admitted to our hospital were analyzed retrospectively. Embolization methods and therapeutic effects of two cases of BAAs were compared.ResultsCase 1 was that of an intact true BAA inside the mediastinum located at the opening of the bronchial artery. The distal end of the aneurysm was embolized, and tumor cavity was occluded. No recurrence of BAA was found after the operation. Case 2 was that of a ruptured and hemorrhagic pseudobronchial aneurysm of the mediastinum. Coil embolization combined with covered stent graft exclusion of the thoracic aorta were performed, and the left bronchial artery and BAA were almost occluded. Nine months postoperatively, the mediastinal hematoma was almost completely absorbed.ConclusionEndovascular embolization has become the most commonly used for the treatment of BAA. Different methods should be selected according to the location and nature of the aneurysm.

Role of multi detector computed tomography (MDCT) angiography in the management of patients with haemoptysis

Haemoptysis is one of the deadliest symptoms of respiratory illness. Identifying the etiology and source of haemoptysis plays a crucial role in early diagnosis and planning for appropriate management. The aim of the study was to evaluate the role of MDCT angiography in identifying the site, cause and source of haemoptysis along with determining the normal variants of bronchial arteries. A prospective study was performed on 50 patients with complaints of haemoptysis for a period of 18 months. MDCT angiography was performed to interpret site and source of bleed. Tuberculosis (44%) was the most common underlying cause of haemoptysis in a cohort of 50 patients. In most patients, bronchial artery was adjudged to the source of haemoptysis (72%), followed by the pulmonary artery. Non bronchial systemic arteries contributed to haemoptysis in 12% of patients. A total of 145 bronchial arteries were detected, out of which 75 were right bronchial arteries (51%) and 71 left bronchial arteries (49%). The combination of 2 right bronchial arteries and 1 left bronchial artery was the most common (18%) branching pattern in this study. MDCT angiography is a robust diagnostic tool that permits visualisation of pulmonary vasculature involved in haemoptysis, thereby effectuating suitable treatment in time, and possibly reduce associated mortality rates.

Variations of bronchial artery origin in 600 patients: Systematic analysis with multidetector computed tomography and digital subtraction angiography.

To identify and evaluate the spectrum and prevalence of variations in bronchial artery (BA) origin by multidetector computed tomography (MDCT) and digital subtraction angiography (DSA) in a large population with hemoptysis.From July 2008 to June 2015, data from 600 individuals with hemoptysis who underwent MDCT and DSA were retrospectively analyzed. The pattern of BA origin was investigated and classified according to distribution.A total of 1674 BAs were evaluated, 866 were right BA and 808 were left BA. Most BAs originated from the upper descending thoracic aorta, classified as orthotopic origin (n = 1464, 87.5%). Among ectopic origin BAs (n = 210, 12.5%), concavity of the aortic arch was the most common (n = 107). The most common distribution pattern was a single artery in each side (n = 262). According to our classification, Type I was most common (n = 457), including BAs originating in orthotopic fashion from the descending thoracic aorta. Type II (n = 2) was defined as BAs originating from the aortic arch or ascending aorta. Type III (not found) was defined as BAs originating from subclavian arteries, common carotid arteries, and their branch vessels. Type IV (n = 92) was Type I and II combined, Type V (n = 41) was Type I and III combined, Type VI (not found) was Type II and III combined, and Type VII (n = 8) was Type I, II, and III combined.Variations of BA origin could be systematically described in detail.

Severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection

BackgroundSince the beginning of SARS-CoV-2 outbreak in China, severe acute respiratory syndrome has been widely descripted. Hemoptysis has rarely been observed in SARS-CoV-2 infection.We report here a case of severe hemoptysis in post-tuberculosis bronchiectasis precipitated by SARS-CoV-2 infection and managed in a referral center.Case presentationA 58-year-old man was admitted to our intensive care unit for severe hemoptysis with history of post-tuberculosis bronchiectasis. At ICU admission the patient had fever and severe acute respiratory failure requiring high flow oxygen therapy. Respiratory tract sampling was positive for SARS-CoV-2. Multi-detector computed tomography angiography pointed out localized bronchiectasis on the left lower lobe and enlarged left bronchial and phrenic arteries; bronchial arteriography with distal embolization was performed with favorable outcome and no bleeding recurrence.ConclusionsTo our knowledge, this is the first case of acute exacerbation of bronchiectasis related to SARS-CoV-2 infection and complicated by severe hemoptysis. Whether the virus may play a role in the dysregulation of airway haemostasis, and contribute to episodes of hemoptysis in patients with chronic pulmonary diseases and predisposing factors might be investigated.

Rekurentne hemoptizije uzrokovane arteriovenskom malformacijom

Pulmonary arteriovenous malformation is a rare disorder of pulmonary vascularization. We are going to describe the case of recurring hemoptysis with a patient who was diagnosed late with pulmonary AV malformation. The 68-yearold patient was hospitalized for the fourth time in the Clinic for Pulmonology, Clinical Center of Kragujevac due to recurring hemoptysis. Bronchoscopy was conducted which showed no signs of bleeding nor new changes in the bronchial lumen. MSCT of the chest eliminated the possibility of bronchiectasis as the cause for hemoptysis. Chest MSCT was repeated, and it was without evolutionary aspect when compared to the previous one. In April 2019, at the Military Medical Academy in Belgrade, the patient had bronchoscopy performed, the results were normal, and the examination was completed with exploration, along with selective angiography, where AV shunt could be seen on the left side. Since the diameter of the left bronchial artery was less than 2 mm, it was not possible to place the micro-catheter and do embolization, but hemostasis was done by manual compression, which lasted for 10 minutes. After six months of follow-up examinations, no complications were registered with the patient. The method of choice for diagnosing PAV malformation is bronchial angiography, while other chest radiographic methods are not reliable. Embolization is the method of choice for treating this disorder.

HEMOPTYSIS IN EISENMENGER SYNDROME-ASSOCIATED PULMONARY ARTERIAL HYPERTENSION (PAH): FORGOT ABOUT BRONCHIAL ARTERY EMBOLIZATION

SESSION TITLE: Pulmonary Vascular Disease SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/23/2019 8:45 AM - 9:45 AM INTRODUCTION: Anticoagulation in Eisenmenger syndrome (ES) associated PAH (ES-PAH) presents a clinical challenge, as there is both an increased prevalence of pulmonary artery thrombosis and hemoptysis. We present a case of ES-PAH complicated by hemoptysis and treated successfully with multi-vessel bronchial artery embolization (BAE). CASE PRESENTATION: A 52-year-old female with an atrial septal defect complicated by ES-PAH treated with continuous epoprostenol infusion, ambrisentan, supplemental oxygen, and thrombophilia previously managed with warfarin; presented with a one-week history with multiple episodes of hemoptysis and chest tightness. She reported a similar episode of hemoptysis one-year previously with no specific source of bleeding identified. At the time of her hemoptysis had resolved with discontinuation of warfarin.On this presentation, her vital signs were unremarkable on 3 LPM nasal cannula. Physical examination demonstrated a right ventricular heave, a loud and prominent P2, and a third heart sound. Electrocardiography revealed normal sinus rhythm and bifascicular block (RBBB and LPFB). CT angiography (CTA) of the chest demonstrated dilated bronchial arteries and patchy ground glass opacities within the left upper and lower lobes, consistent with alveolar hemorrhage.Otorhinolaryngology and interventional pulmonology found no discrete bleeding in the upper or lower respiratory tract. After discussion, prophylactic embolization of the dilated right and left bronchial arteries was performed successfully. No further episodes of hemoptysis were reported post embolization. On outpatient follow-up the patient has remain hemoptysis free. DISCUSSION: Eisenmenger physiology results from chronic left-to-right shunting of blood, leading to increased right-sided pressures, and reversal of shunt flow. Patients with ES-PAH are at increased risk of pulmonary artery thrombosis with concurrent increased risk of hemoptysis and pulmonary hemorrhage(1). Thrombo-embolic risks include atrial fibrillation and indwelling central catheters. Hemoptysis is often due to bronchial artery dilatation and/or rupture. The use of anticoagulation in ES-PAH patients is controversial due to balancing risk between thrombosis and hemoptysis, and survival benefits are unclear(2). BAE in PAH patients is more complex than in patients without PAH, due to frequent higher numbers of culprit arteries and increased anatomical/morphological variability(3). However, BAE has been demonstrated to be a safe and reliable intervention for hemoptysis in PAH3. There is no definitive treatment and repeated BAE for reoccurrence is common. CONCLUSIONS: Anticoagulation in ES-PAH should be used conservatively in an individualized approach. Hemoptysis is an uncommon in ES-PAH and may result from bronchial artery dilatation and rupture. We demonstrated the safety of multi-vessel BAE in ES-PAH and encourage its consideration within this cohort. Reference #1: Wan D, Tsui C, Kiess M, et al. Anticoagulation for Thromboembolic Risk Reduction in Adults With Congenital Heart Disease. Canadian Journal of Cardiology 2017; 33: 1597–1603. Reference #2: Sandoval J, Santos LE, Córdova J, et al. Does Anticoagulation in Eisenmenger Syndrome Impact Long-term Survival?: Anticoagulation in Eisenmenger Syndrome. Congenital Heart Disease 2012; 7: 268–276. Reference #3: Rasciti E, Sverzellati N, Silva M, et al. Bronchial artery embolization for the treatment of haemoptysis in pulmonary hypertension. La radiologia medica 2017; 122: 257–264. DISCLOSURES: No relevant relationships by Olayiwola Amoran, source=Web Response no disclosure on file for Christine Archer-Chicko; Advisory Committee Member relationship with Actelion/Janssen Please note: $5001 - $20000 Added 02/07/2019 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 02/07/2019 by Harold Palevsky, source=Web Response, value=Honoraria DSMB relationship with Eiger Please note: $1001 - $5000 Added 02/07/2019 by Harold Palevsky, source=Web Response, value=Honoraria No relevant relationships by cyrus vahdatpour, source=Web Response

Case Report: A Rare Case of Coronary-Bronchial Fistula Associated with a Large Lung Bullae and Bronchiectasis Presenting as Dyspnea

Coronary artery fistulas (CAF) are rare but hemodynamically significant anomalies. Although asymptomatic, they can be associated with several cardiorespiratory conditions. Coronary to bronchial fistulas (CBF) account for 0.5% to 0.61% of coronary artery fistulas, with fistulas arising from the right coronary artery being exceedingly rare. These fistulas are known to be associated with bronchiectasis but not lung bullae. The following paper reports a rare case of a coronary to bronchial fistula associated to bronchiectasis and lung bullae. The patient presented for dyspnea and was found to have a large lung bullae, bronchiectasis and a coronary to bronchial artery fistula arising from the right coronary artery and terminating into the left bronchial artery. The CBF was successfully managed first with percutaneous microcoil embolization then the bullae was resected thoracoscopically three days later. However, more case reports are mandatory in order to further understand the etiology and pathophysiology of these fistulas, elucidate their relationship to other pathologies such as bronchiectasis and lung bullae and determine the optimal therapeutic measures.

MDCT angiography mapping of abnormal bronchopulmonary vasculature in patients with haemoptysis

BackgroundThe systematic use of MDCT angiography in patients with haemoptysis is especially helpful to identify ectopic bronchial arteries, non-bronchial systemic arteries and pulmonary artery pseudoaneurysms. Aim of this studyAim of this study is to assess the role of MDCT angiography in the evaluation of abnormal bronchopulmonary vasculature in patients with haemoptysis. ResultsThe study was performed on 36 patients presented with haemoptysis and showing vascular abnormalities on CT angiography. Tuberculosis was the most common underlying disease. Dilated bronchial arteries (BAs) were detected in 86% of patients; they originate between D4 and D6 vertebral levels. About 95% of right BAs have their ostia between 9 and 10o’clock positions, while 75% of left BAs originated between 11 and 1o’clock positions. This study included 8 non bronchial systemic arteries with the inferior phrenic arteries were the most common. Significant pleural thickening (>3 mm) may predict non-bronchial arterial supply. Pulmonary arteries had a role in haemoptysis in only 2 patients. ConclusionThis study has shown that MDCT angiography is a valuable non invasive diagnostic tool in the evaluation of haemoptysis. It provides a roadmap of the vascular abnormalities and aids in the diagnosis of the underlying disease.

Mediastinoscopic view of the bronchial arteries in a series of surgical cases evaluated with three-dimensional computed tomography.

We have routinely performed three-dimensional computed tomography (3-D CT) prior to video-assisted transmediastinal esophagectomy to evaluate the small arteries in the mediastinal operative field. This evaluation would be helpful in performing mediastinoscopic esophagectomy. Thirty-one patients who underwent transmediastinal esophagectomy with preoperative evaluations by 3-D CT were the study subject. The bronchial arteries depicted by the 3-D CT were classified by their origin and laterality. In 18 of the 31 cases, the surgical video was available and the identification rate in the video was reviewed for each of the categorized bronchial arteries. The detection rates of each classified artery were as follows (abbreviations, detection rate); the intercostal-bronchial trunk (IBT, 22/31), the direct left bronchial artery (LBA, 17/31), the common trunk of bronchial arteries (CTB, 7/31), the direct right bronchial artery (RBA, 2/31), and the ectopic arteries (16/31). The ectopic arteries arose from the aortic arch (11 cases), the right subclavian artery (6 cases) or the left subclavian artery (1 case). The identification rates of IBT, LBA, CTB, RBA and any of the ectopic arteries in the video review were 12/13, 4/8, 3/4, 1/1 and 2/10, respectively. Preoperative 3-D CT was a highly sensitive evaluation for the bronchial arteries encountered during transmediastinal esophagectomy. Orthotopic arteries except for LBA were frequently identified at the predicted sites. Although RBA and CTB were present infrequently, they often flowed into regional nodes at the bilateral bronchi or the tracheal bifurcation and, therefore, should be preoperatively evaluated.

An applied anatomical study of bronchial artery.

The aim of this study was to reveal the external features of the bronchial artery (BA) system, so as to provide morphological basis for clinic. The BAs in 48 adult cadavers were dissected and analyzed. The number of BAs in 48 cases was 118. The incidence of BA arising from thoracic aorta, right posterior intercostal artery, and right subclavian artery was 69.49, 27.12, and 3.39%, respectively. The origin of BAs in individual specimen might be single, two, or all of them, respectively. According to the different origin and/or origins of BAs, it could be divided into five categories. As for the course of BAs, in this study, all the left BAs arising from thoracic aorta passed forward around the left side of esophagus and then entered left pulmonary hilum; most (n = 15) of the right BAs arising from thoracic aorta passed forward around the left side of esophagus and then entered right pulmonary hilum; a few (n = 8) of the right BAs arising from thoracic passed forward the right side of esophagus and bronchus and then entered right pulmonary hilum. Besides, in our group, the special courses were that right intercostal-bronchial trunk (RICBT) arising from thoracic aorta passed between vertebra and esophagus and gave off BA which curved forward around the right side of esophagus and then entered right pulmonary hilum, common bronchial trunk (CBT) arising from thoracic aorta passed forward around the left side of esophagus laying anterior to bronchus or posterior to bronchus, then dividing into a left and a right BAs entering right and left pulmonary hilum, respectively. In 4 cadavers, the RICBT gave off the radiculomedullary artery and BA in turn, so radiculomedullary artery has the same origin with BA. Of all BAs, the mean diameter of right posterior intercostal artery, CBT, left BA, and right BA was 2.17 ± 0.84, 1.79 ± 0.57, 1.44 ± 0.50, and 1.39 ± 0.38mm, respectively. The information gained from this study will be of value in clinic application.

Morphological Analysis of Bronchial Arteries and Variants with Computed Tomography Angiography.

The aim of our study was to determine the prevalence of anatomical variants of bronchial arteries using computed tomographic angiography in a population of northeastern Mexico. An observational, transversal, descriptive, comparative, retrospective study was performed using 139 imaging studies of Mexican patients in which we evaluated the following parameters from the left and right bronchial arteries: artery origin, branching pattern, arterial ostium, vertebral level of origin, diameter, and mediastinal trajectory. The anatomies of the bronchial arteries were similar in both genders, except distribution for vertebral origin level (p 0.006) and the diameter (p 0.013). Left and right arteries were similar, except for the mediastinal trajectory in reference to the esophagus (p < 0.001) as well as the arterial diameter (p < 0.001) and lumen diameter.

A new anatomical classification of the bronchial arteries based on the spatial relationships to the esophagus and the tracheobronchus.

To reveal the patterns of the mediastinal course of the bronchial arteries (BAs). The BAs were dissected to determine the positional relationships of their mediastinal courses with the tracheobronchus and the esophagus in 72 adult cadavers. The mediastinal courses of the 227 BAs found in this study were classified into 4 types. There were 61 and 163 BAs passing the right side (Type I) and the left side (Type II reaching dorsal surface (n=98), or Type III reaching ventral surface (n=65) of the tracheobronchus) of the esophagus, respectively. Three BAs originated from the subclavian artery (Type IV). All Type I BAs were right BAs, whereas 91.8% of the Type II BAs were left BAs. However, 43.1 and 56.9% of the Type III BAs were the right and left BAs, respectively. The classification of the mediastinal course of the BAs determined by the spatial relationships to the tracheobronchus and the esophagus may be clinically useful, because each category of this classification can be determined during esophagectomy and indicates whether the BA is a right or left BA.