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Hemoptysis: Bronchial and Nonbronchial Systemic Arteries at 16–Detector Row CT¹

¹ From the Department of Radiology and Center for Imaging Science (Y.C.Y., K.S.L., Y.J.J., S.W.S., M.J.C.) and Department of Medicine, Division of Pulmonary and Critical Care Medicine (O.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea. Received December 22, 2003; revision requested March 2, 2004; revision received March 11; accepted April 8; updated April 27. Address correspondence to K.S.L. (e-mail: kyungs.lee@samsung.com).

View larger version (89K): [in a new window]   Figure 1a. (a) Transverse 1.25-mm-thick and oblique (b) sagittal and (c) coronal 1.0-mm-thick CT images with MPR in a 35-year-old man with bronchiectasis and episodes of nonmassive hemoptysis show a left bronchial artery (arrow) of 3 mm in diameter. It arises from the aorta at the level of T6 and is traceable to the hilum. (d) Selective left bronchial angiogram shows enlarged and tortuous bronchial artery (arrow) with bronchial-pulmonary arterial shunting.

View larger version (116K): [in a new window]   Figure 1b. (a) Transverse 1.25-mm-thick and oblique (b) sagittal and (c) coronal 1.0-mm-thick CT images with MPR in a 35-year-old man with bronchiectasis and episodes of nonmassive hemoptysis show a left bronchial artery (arrow) of 3 mm in diameter. It arises from the aorta at the level of T6 and is traceable to the hilum. (d) Selective left bronchial angiogram shows enlarged and tortuous bronchial artery (arrow) with bronchial-pulmonary arterial shunting.

View larger version (88K): [in a new window]   Figure 1c. (a) Transverse 1.25-mm-thick and oblique (b) sagittal and (c) coronal 1.0-mm-thick CT images with MPR in a 35-year-old man with bronchiectasis and episodes of nonmassive hemoptysis show a left bronchial artery (arrow) of 3 mm in diameter. It arises from the aorta at the level of T6 and is traceable to the hilum. (d) Selective left bronchial angiogram shows enlarged and tortuous bronchial artery (arrow) with bronchial-pulmonary arterial shunting.

View larger version (165K): [in a new window]   Figure 1d. (a) Transverse 1.25-mm-thick and oblique (b) sagittal and (c) coronal 1.0-mm-thick CT images with MPR in a 35-year-old man with bronchiectasis and episodes of nonmassive hemoptysis show a left bronchial artery (arrow) of 3 mm in diameter. It arises from the aorta at the level of T6 and is traceable to the hilum. (d) Selective left bronchial angiogram shows enlarged and tortuous bronchial artery (arrow) with bronchial-pulmonary arterial shunting.

View larger version (137K): [in a new window]   Figure 2a. (a) Selective right bronchial angiogram in a 29-year-old man with tuberculosis and recurrent episodes of massive hemoptysis shows a normal right bronchial artery (arrow) with intercostobronchial trunk. (b) Oblique coronal 1.0-mm-thick CT image with MPR shows a right bronchial artery (arrow) of 3.1 mm in diameter arising from aorta at the level of T5. It is not traceable to the hilum. (c) Selective angiogram of common bronchial trunk shows an enlarged left bronchial artery (arrow) with hypervascularity of the left upper lobe and a normal right bronchial artery (arrowhead). (d) Three-dimensional CT image shows a right bronchial artery (black arrow) and a left bronchial artery arising from the aorta at the level of T5-T6 and traceable to the hilum (white arrow), much like at angiography. A small vascular structure (arrowhead), which may be the right bronchial artery with common trunk seen at angiography, is visible.

View larger version (110K): [in a new window]   Figure 2b. (a) Selective right bronchial angiogram in a 29-year-old man with tuberculosis and recurrent episodes of massive hemoptysis shows a normal right bronchial artery (arrow) with intercostobronchial trunk. (b) Oblique coronal 1.0-mm-thick CT image with MPR shows a right bronchial artery (arrow) of 3.1 mm in diameter arising from aorta at the level of T5. It is not traceable to the hilum. (c) Selective angiogram of common bronchial trunk shows an enlarged left bronchial artery (arrow) with hypervascularity of the left upper lobe and a normal right bronchial artery (arrowhead). (d) Three-dimensional CT image shows a right bronchial artery (black arrow) and a left bronchial artery arising from the aorta at the level of T5-T6 and traceable to the hilum (white arrow), much like at angiography. A small vascular structure (arrowhead), which may be the right bronchial artery with common trunk seen at angiography, is visible.

View larger version (143K): [in a new window]   Figure 2c. (a) Selective right bronchial angiogram in a 29-year-old man with tuberculosis and recurrent episodes of massive hemoptysis shows a normal right bronchial artery (arrow) with intercostobronchial trunk. (b) Oblique coronal 1.0-mm-thick CT image with MPR shows a right bronchial artery (arrow) of 3.1 mm in diameter arising from aorta at the level of T5. It is not traceable to the hilum. (c) Selective angiogram of common bronchial trunk shows an enlarged left bronchial artery (arrow) with hypervascularity of the left upper lobe and a normal right bronchial artery (arrowhead). (d) Three-dimensional CT image shows a right bronchial artery (black arrow) and a left bronchial artery arising from the aorta at the level of T5-T6 and traceable to the hilum (white arrow), much like at angiography. A small vascular structure (arrowhead), which may be the right bronchial artery with common trunk seen at angiography, is visible.

View larger version (138K): [in a new window]   Figure 2d. (a) Selective right bronchial angiogram in a 29-year-old man with tuberculosis and recurrent episodes of massive hemoptysis shows a normal right bronchial artery (arrow) with intercostobronchial trunk. (b) Oblique coronal 1.0-mm-thick CT image with MPR shows a right bronchial artery (arrow) of 3.1 mm in diameter arising from aorta at the level of T5. It is not traceable to the hilum. (c) Selective angiogram of common bronchial trunk shows an enlarged left bronchial artery (arrow) with hypervascularity of the left upper lobe and a normal right bronchial artery (arrowhead). (d) Three-dimensional CT image shows a right bronchial artery (black arrow) and a left bronchial artery arising from the aorta at the level of T5-T6 and traceable to the hilum (white arrow), much like at angiography. A small vascular structure (arrowhead), which may be the right bronchial artery with common trunk seen at angiography, is visible.

View larger version (92K): [in a new window]   Figure 3a. (a) Maximum intensity projection and (b) volume-rendered CT images in a 51-year-old woman with tuberculosis and recurrent episodes of massive hemoptysis show a right bronchial artery (arrowheads) of 3.2 mm in diameter arising from right internal mammary artery (arrows). Selective right internal mammary angiography was not performed because aortogram (not shown) did not show this vessel.

View larger version (143K): [in a new window]   Figure 3b. (a) Maximum intensity projection and (b) volume-rendered CT images in a 51-year-old woman with tuberculosis and recurrent episodes of massive hemoptysis show a right bronchial artery (arrowheads) of 3.2 mm in diameter arising from right internal mammary artery (arrows). Selective right internal mammary angiography was not performed because aortogram (not shown) did not show this vessel.

View larger version (164K): [in a new window]   Figure 4a. (a) Selective left subclavian angiogram in a 41-year-old man with recurrent episodes of massive hemoptysis shows an enlarged and tortuous lateral thoracic artery (arrow) with shunting to pulmonary artery. Also note parenchymal destruction as a result of previous pulmonary tuberculosis. (b) Transverse 1.25-mm-thick CT image shows tortuous vascular structure (arrow) in subpleural fat with thickening of adjacent pleura (arrowhead). (c) Three-dimensional volume-rendered CT image shows a tortuous artery (arrow) arising from left subclavian artery (arrowhead).

View larger version (158K): [in a new window]   Figure 4b. (a) Selective left subclavian angiogram in a 41-year-old man with recurrent episodes of massive hemoptysis shows an enlarged and tortuous lateral thoracic artery (arrow) with shunting to pulmonary artery. Also note parenchymal destruction as a result of previous pulmonary tuberculosis. (b) Transverse 1.25-mm-thick CT image shows tortuous vascular structure (arrow) in subpleural fat with thickening of adjacent pleura (arrowhead). (c) Three-dimensional volume-rendered CT image shows a tortuous artery (arrow) arising from left subclavian artery (arrowhead).

View larger version (200K): [in a new window]   Figure 4c. (a) Selective left subclavian angiogram in a 41-year-old man with recurrent episodes of massive hemoptysis shows an enlarged and tortuous lateral thoracic artery (arrow) with shunting to pulmonary artery. Also note parenchymal destruction as a result of previous pulmonary tuberculosis. (b) Transverse 1.25-mm-thick CT image shows tortuous vascular structure (arrow) in subpleural fat with thickening of adjacent pleura (arrowhead). (c) Three-dimensional volume-rendered CT image shows a tortuous artery (arrow) arising from left subclavian artery (arrowhead).

View larger version (94K): [in a new window]   Figure 5a. (a) Selective left internal mammary angiogram in a 24-year-old man with tuberculosis and recurrent episodes of massive hemoptysis shows an enlarged and tortuous artery (black arrow) arising from left internal mammary artery (white arrow). With its hypervascularity and parenchymal staining, it was regarded as a nonbronchial systemic artery causing hemoptysis. (b) Three-dimensional volume-rendered CT image shows enlarged and tortuous vascular structures (arrowhead) in left mediastinum arising from the left subclavian artery (arrow). Structures were not seen on an aortogram. An abnormal vessel arising from left internal mammary artery at angiography was not detected at CT.

View larger version (152K): [in a new window]   Figure 5b. (a) Selective left internal mammary angiogram in a 24-year-old man with tuberculosis and recurrent episodes of massive hemoptysis shows an enlarged and tortuous artery (black arrow) arising from left internal mammary artery (white arrow). With its hypervascularity and parenchymal staining, it was regarded as a nonbronchial systemic artery causing hemoptysis. (b) Three-dimensional volume-rendered CT image shows enlarged and tortuous vascular structures (arrowhead) in left mediastinum arising from the left subclavian artery (arrow). Structures were not seen on an aortogram. An abnormal vessel arising from left internal mammary artery at angiography was not detected at CT.