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Bronchial and Nonbronchial Systemic Arteries at Multi–Detector Row CT Angiography: Comparison with Conventional Angiography¹

¹ From the Department of Radiology, Hôpital Calmette, University Center of Lille, Blvd Jules Leclerc, 59037 Lille, France. Received January 9, 2004; revision requested March 11; revision received April 1; accepted May 17. Address correspondence to M.R.J. (e-mail: mremy-jardin@chru-lille.fr).

View larger version (174K): [in a new window]   Figure 1a. Images in a 22-year-old woman with cystic fibrosis and recurrent moderate hemoptysis originating from the right upper lobe. (a) Volume-rendered CT image of thoracic vessels and posterior bone structures shows an enlarged right bronchial artery (arrows) originating from a right intercostobronchial trunk, with a tortuous mediastinal course. (b) Selective arteriogram demonstrates an enlarged and tortuous right bronchial artery (arrows) arising from the right intercostobronchial trunk.

View larger version (164K): [in a new window]   Figure 1b. Images in a 22-year-old woman with cystic fibrosis and recurrent moderate hemoptysis originating from the right upper lobe. (a) Volume-rendered CT image of thoracic vessels and posterior bone structures shows an enlarged right bronchial artery (arrows) originating from a right intercostobronchial trunk, with a tortuous mediastinal course. (b) Selective arteriogram demonstrates an enlarged and tortuous right bronchial artery (arrows) arising from the right intercostobronchial trunk.

View larger version (139K): [in a new window]   Figure 2. Image in a 68-year-old woman with bilateral bronchiectasis and massive hemoptysis originating from the right lung. Sagittal 10-mm-thick MIP obtained from multi-detector row CT illustrates the ectopic origin of right bronchial artery (arrows) originating from the right subclavian artery (*).

View larger version (191K): [in a new window]   Figure 3a. Images in a 54-year-old woman with bilateral bronchiectasis and recurrent moderate hemoptysis originating from the left lower lobe, with history of successful embolization of right bronchial arteries 10 years earlier. (a) Sagittal 15-mm-thick MIP obtained from multi-detector row CT of descending aorta depicts a small-sized ectopic left bronchial artery (arrow) originating from the anterior wall of the descending aorta at T7-T8 level. (b) Selective arteriogram of ectopic left bronchial artery shows tortuous enlargement of the artery (arrows), with parenchymal staining and bronchial-to-pulmonary shunting. Embolization of this artery after that of the common trunk for right and left sides and during the same session enabled immediate cessation of bleeding.

View larger version (189K): [in a new window]   Figure 3b. Images in a 54-year-old woman with bilateral bronchiectasis and recurrent moderate hemoptysis originating from the left lower lobe, with history of successful embolization of right bronchial arteries 10 years earlier. (a) Sagittal 15-mm-thick MIP obtained from multi-detector row CT of descending aorta depicts a small-sized ectopic left bronchial artery (arrow) originating from the anterior wall of the descending aorta at T7-T8 level. (b) Selective arteriogram of ectopic left bronchial artery shows tortuous enlargement of the artery (arrows), with parenchymal staining and bronchial-to-pulmonary shunting. Embolization of this artery after that of the common trunk for right and left sides and during the same session enabled immediate cessation of bleeding.

View larger version (143K): [in a new window]   Figure 4a. Images in a 75-year-old man with recurrent moderate hemoptysis complicating massive acute pulmonary embolism and infected left upper-lobe infarction. Bronchoscopy performed prior to angiography revealed left upper-lobe bronchial bleeding. (a, b) Oblique coronal 10-mm-thick MIPs obtained from multi-detector row CT of thoracic vessels demonstrate abnormal nonbronchial systemic supply (arrows) to the infarcted left upper-lobe area arising from the axillary artery (arrowhead). (c) Selective arteriogram of the left lateral thoracic artery demonstrates filling of the nonbronchial systemic arterial supply (arrows) to the left upper lobe. Bleeding ceased immediately after embolization of this systemic artery.

View larger version (144K): [in a new window]   Figure 4b. Images in a 75-year-old man with recurrent moderate hemoptysis complicating massive acute pulmonary embolism and infected left upper-lobe infarction. Bronchoscopy performed prior to angiography revealed left upper-lobe bronchial bleeding. (a, b) Oblique coronal 10-mm-thick MIPs obtained from multi-detector row CT of thoracic vessels demonstrate abnormal nonbronchial systemic supply (arrows) to the infarcted left upper-lobe area arising from the axillary artery (arrowhead). (c) Selective arteriogram of the left lateral thoracic artery demonstrates filling of the nonbronchial systemic arterial supply (arrows) to the left upper lobe. Bleeding ceased immediately after embolization of this systemic artery.

View larger version (160K): [in a new window]   Figure 4c. Images in a 75-year-old man with recurrent moderate hemoptysis complicating massive acute pulmonary embolism and infected left upper-lobe infarction. Bronchoscopy performed prior to angiography revealed left upper-lobe bronchial bleeding. (a, b) Oblique coronal 10-mm-thick MIPs obtained from multi-detector row CT of thoracic vessels demonstrate abnormal nonbronchial systemic supply (arrows) to the infarcted left upper-lobe area arising from the axillary artery (arrowhead). (c) Selective arteriogram of the left lateral thoracic artery demonstrates filling of the nonbronchial systemic arterial supply (arrows) to the left upper lobe. Bleeding ceased immediately after embolization of this systemic artery.

View larger version (115K): [in a new window]   Figure 5a. Images in a 67-year-old woman with bilateral bronchiectasis and massive hemoptysis originating from the right lung. Hemoptysis recurred after successful embolization of the right intercostobronchial trunk 2 days earlier. (a, b) Contiguous 10-mm-thick coronal MIPs obtained from multi-detector row CT of thoracic vessels demonstrate nonbronchial systemic collateral supply (arrows) to the right lower lobe arising from the right inferior phrenic artery (arrowhead). (c) Selective arteriogram demonstrates the abnormal systemic artery (arrows), with subsequent embolization. Arrowhead points to the origin of the abnormal systemic artery from the celiac trunk. Bleeding ceased immediately after second embolization.

View larger version (112K): [in a new window]   Figure 5b. Images in a 67-year-old woman with bilateral bronchiectasis and massive hemoptysis originating from the right lung. Hemoptysis recurred after successful embolization of the right intercostobronchial trunk 2 days earlier. (a, b) Contiguous 10-mm-thick coronal MIPs obtained from multi-detector row CT of thoracic vessels demonstrate nonbronchial systemic collateral supply (arrows) to the right lower lobe arising from the right inferior phrenic artery (arrowhead). (c) Selective arteriogram demonstrates the abnormal systemic artery (arrows), with subsequent embolization. Arrowhead points to the origin of the abnormal systemic artery from the celiac trunk. Bleeding ceased immediately after second embolization.

View larger version (151K): [in a new window]   Figure 5c. Images in a 67-year-old woman with bilateral bronchiectasis and massive hemoptysis originating from the right lung. Hemoptysis recurred after successful embolization of the right intercostobronchial trunk 2 days earlier. (a, b) Contiguous 10-mm-thick coronal MIPs obtained from multi-detector row CT of thoracic vessels demonstrate nonbronchial systemic collateral supply (arrows) to the right lower lobe arising from the right inferior phrenic artery (arrowhead). (c) Selective arteriogram demonstrates the abnormal systemic artery (arrows), with subsequent embolization. Arrowhead points to the origin of the abnormal systemic artery from the celiac trunk. Bleeding ceased immediately after second embolization.

View larger version (111K): [in a new window]   Figure 6a. Images in a 19-year-old man with chronic recurrent minor hemoptysis originating from the right lower lobe. (a) Inferior-superior MIP obtained from multi-detector row CT of the lower lung zones and (b) anterior volume-rendered CT image of the thoracolumbar region depict the abnormal systemic artery (arrows) supplying the posterobasal segment of the right lower lobe and its origin from the anterior wall of the descending aorta. (c) Selective arteriogram demonstrates the abnormal systemic artery (arrows) prior to coil deposition, enabling its complete occlusion.

View larger version (123K): [in a new window]   Figure 6b. Images in a 19-year-old man with chronic recurrent minor hemoptysis originating from the right lower lobe. (a) Inferior-superior MIP obtained from multi-detector row CT of the lower lung zones and (b) anterior volume-rendered CT image of the thoracolumbar region depict the abnormal systemic artery (arrows) supplying the posterobasal segment of the right lower lobe and its origin from the anterior wall of the descending aorta. (c) Selective arteriogram demonstrates the abnormal systemic artery (arrows) prior to coil deposition, enabling its complete occlusion.

View larger version (153K): [in a new window]   Figure 6c. Images in a 19-year-old man with chronic recurrent minor hemoptysis originating from the right lower lobe. (a) Inferior-superior MIP obtained from multi-detector row CT of the lower lung zones and (b) anterior volume-rendered CT image of the thoracolumbar region depict the abnormal systemic artery (arrows) supplying the posterobasal segment of the right lower lobe and its origin from the anterior wall of the descending aorta. (c) Selective arteriogram demonstrates the abnormal systemic artery (arrows) prior to coil deposition, enabling its complete occlusion.