Anomalous systemic artery to a normal lung: a rare cause of hemoptysis in adults (original) (raw)
Related papers
Multi-detector CT imaging of bronchial & non-bronchial systemic arteries
Diagnostic and Interventional Radiology, 2009
he lungs have one of the largest blood supplies in the human body. Their rich circulation is supplied via two separate vascular systems: the pulmonary and bronchial arteries. The pulmonary arteries are the most important component of these systems and provide 99% of the arterial blood to the lungs for gas exchange. Bronchial arteries primarily deliver blood to the trachea, extra-and intrapulmonary airways, bronchovascular bundles, nerves, supporting structures, regional lymph nodes, visceral pleura, esophagus, the vasa vasorum of the aorta, and pulmonary arteries and veins. Pulmonary and bronchial arteries have rich and complex anastomoses at the capillary level (1, 2). The non-bronchial systemic arterial supply to the lungs should be considered in cases of pleural thickening greater than 3 mm, as should the enlarged and tortuous enhancing arteries within the extrapleural fat that result from parenchymal lung disease. These anatomical changes are considered to be the result of reduced pulmonary arterial perfusion and chronic inflammation (1, 3, 4). The computed tomography (CT) depiction of bronchial and NBSAs is primarily influenced by the size and course of these arteries and the technique used to scan the lungs. Enlarged bronchial arteries can easily be visualized as nodular or tubular structures within the mediastinum, around the central airways, or within the extrapleural fat planes on contrast-enhanced CT images (2, 4, 5). Several diseases that affect the pulmonary vascular system may give rise to enlarged bronchial and NBSAs that are primarily caused by chronic thromboembolic disease and vasculitic connective tissue diseases (Figs. 1 and 2). However, chronic inflammatory problems of the lung parenchyma and airways, for example, bronchiectasis (Figs. 3-8), chronic bronchitis, tuberculosis, and chronic fungal infections, can also be underlying disorders. Furthermore, malignant diseases of the lungs are also possible culprit lesions that result in the same clinical picture. The aforementioned chronic inflammatory diseases may also affect the pleural surfaces and cause hypertrophic and tortuous NBSAs within the extrapleural fat (1-4). The most important and potentially catastrophic clinical outcome of these enlarged vessels is rupture which leads to hemoptysis. Rupture is usually caused by elevated regional blood pressures or vessel wall erosion by bacterial pathogens. In such patients, multidetector (MDCT) angiography is an important potential diagnostic modality for the accurate and prompt diagnosis of the underlying vascular disorder because it provides a map of these vascular structures. The mapping and the depiction of these vessels are of utmost importance for an effective pretreatment, mainly before embolization of the bronchial arteries, in work up of severely affected patients unresponsive to supportive and conservative measures (4).
Open Journal of Medical Imaging, 2014
Purpose: To evaluate the role of multislice computed angiography of the bronchial arteries and nonbronchial systemic arteries in patients with hemoptysis when performed before arterial embolization procedure. Materials and Methods: Twenty-eight patients with hemoptysis underwent multislice CT angiography of the bronchial arteries with dual-source 64 × 2 detector row scanner before embolization. The transverse CT images as well as the multiplanar reconstructions, the maximum intensity projections and the three-dimensional CT images were used for the depiction of bronchial arteries (the total number of the bronchial arteries, the abnormal bronchial arteries, their origin at the aorta and the diameter of the ostium). The presence of nonbronchial systemic arteries regarded as causing hemoptysis was also evaluated. Digital angiography and selective arteriograms of abnormal bronchial and nonbronchial systemic arteries were performed based on the findings of multislice computed tomography (MDCT). Results: Seventy-eight (40 right and 38 left) bronchial arteries were detected at computed angiography (CTA). Forty of the seventy-eight bronchial arteries that were detected at CTA, were considered abnormal. On selective angiography 38 of these bronchial arteries were regarded as causing hemoptysis. Two of these arteries could not be selectively catheterized and therefore could not be evaluated. All 38 bronchial arteries regarded as causing hemoptysis at selective angiography were detected prospectively at CTA as abnormal. Four bronchial arteries that were found to be responsible for hemoptysis had diameter <2 mm. Twelve nonbronchial systemic arteries were considered to be abnormal on CTA * Corresponding author. D. Savvidou et al. 134 scans. Ten of these twelve nonbronchial systemic arteries were regarded on selective angiography as causing hemoptysis. Two of these arteries were found normal on angiography. All 10 nonbronchial arteries regarded as causing hemoptysis were detected at CTA scans. All bronchial and nonbronchial arteries causing hemoptysis were successfully embolized. Conclusion: MDCT angiography allows detailed identification of abnormal bronchial and nonbronchial systemic arteries using a variety of reformatted images, providing a precise road map for the interventional radiologist.
Multi-detector CT imaging of bronchial & non-bronchial systemic arteries
Diagnostic and interventional radiology, 2009
he lungs have one of the largest blood supplies in the human body. Their rich circulation is supplied via two separate vascular systems: the pulmonary and bronchial arteries. The pulmonary arteries are the most important component of these systems and provide 99% of the arterial blood to the lungs for gas exchange. Bronchial arteries primarily deliver blood to the trachea, extra-and intrapulmonary airways, bronchovascular bundles, nerves, supporting structures, regional lymph nodes, visceral pleura, esophagus, the vasa vasorum of the aorta, and pulmonary arteries and veins. Pulmonary and bronchial arteries have rich and complex anastomoses at the capillary level (1, 2). The non-bronchial systemic arterial supply to the lungs should be considered in cases of pleural thickening greater than 3 mm, as should the enlarged and tortuous enhancing arteries within the extrapleural fat that result from parenchymal lung disease. These anatomical changes are considered to be the result of reduced pulmonary arterial perfusion and chronic inflammation (1, 3, 4). The computed tomography (CT) depiction of bronchial and NBSAs is primarily influenced by the size and course of these arteries and the technique used to scan the lungs. Enlarged bronchial arteries can easily be visualized as nodular or tubular structures within the mediastinum, around the central airways, or within the extrapleural fat planes on contrast-enhanced CT images (2, 4, 5). Several diseases that affect the pulmonary vascular system may give rise to enlarged bronchial and NBSAs that are primarily caused by chronic thromboembolic disease and vasculitic connective tissue diseases (Figs. 1 and 2). However, chronic inflammatory problems of the lung parenchyma and airways, for example, bronchiectasis (Figs. 3-8), chronic bronchitis, tuberculosis, and chronic fungal infections, can also be underlying disorders. Furthermore, malignant diseases of the lungs are also possible culprit lesions that result in the same clinical picture. The aforementioned chronic inflammatory diseases may also affect the pleural surfaces and cause hypertrophic and tortuous NBSAs within the extrapleural fat (1-4). The most important and potentially catastrophic clinical outcome of these enlarged vessels is rupture which leads to hemoptysis. Rupture is usually caused by elevated regional blood pressures or vessel wall erosion by bacterial pathogens. In such patients, multidetector (MDCT) angiography is an important potential diagnostic modality for the accurate and prompt diagnosis of the underlying vascular disorder because it provides a map of these vascular structures. The mapping and the depiction of these vessels are of utmost importance for an effective pretreatment, mainly before embolization of the bronchial arteries, in work up of severely affected patients unresponsive to supportive and conservative measures (4).
Oman Medical Journal, 2015
assive hemoptysis is the most serious medical emergency and warrants swift and comprehensive evaluation of the lung parenchyma, airways, and thoracic vasculature. Anomalies of thoracic vasculature constitute an important and uncommon category as causes of hemoptysis. Multidetector computed tomography (MDCT) is the optimal imaging modality for evaluating hemoptysis. In addition to showing the lung parenchyma and airways, it allows the evaluation of the integrity of pulmonary, bronchial, and non-bronchial systemic arteries within the chest. 1,2 Various congenital and acquired anomalies affect the pulmonary vasculature. Awareness of the radiologic manifestations of the disease entities and potential complications secondary to infection, vasculitis, or collateralization may aid early diagnosis. We report the cases of three patients who presented with hemoptysis. The right pulmonary artery was affected in all three, either due to a congenital or acquired cause, and led to systemic collateralization, which resulted in hemoptysis.
2014
Systemic arterialization of the lung without pulmonary sequestration is the rarest form of anomalous systemic arterial supply to the lung. This condition is characterised by an aberrant arterial branch arising from the aorta which supplies an area of lung parenchyma with normal bronchopulmonary anatomy. It is often diagnosed following investigation of an incidental cardiac murmur or based on abnormal imaging, as most patients are asymptomatic or minimally symptomatic. Thoracic computed tomography and computed tomography angiography are generally the most useful diagnostic tests. We present a case of a 22-year old female who was diagnosed with systemic arterial supply to a portion of otherwise normal right lower lobe following investigation of low volume haemoptysis. CASE REPORT Radiology Case. 2014 Mar; 8(3):9-15 Thoracic Radiology: A case of systemic arterial supply to the right lower lobe of the lung: imaging findings and review of the literature Mautone et al.
Tüberküloz ve toraks, 2011
Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient u...
Insights into Imaging
The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. In this review, we provide a simplified imaging approach to the evaluation of the bronchial arteries. We highlight the anatomy and function of the bronchial arteries, typical imaging findings, how to recognize bronchial artery dilatation, and its underlying causes. Contrast-enhanced computer tomography plays a major role in diagnosing bronchial artery enlargement and also improves treatment planning. Bronchial artery embolization has proven to be effective in controlling the potential hazardous hemoptysis.