Bronchial arteries assessment by multi-detector computed tomography in cases of suspected chronic pulmonary thromboembolism and hemoptysis cases

Abstract Background Bronchial arteries are typically small vessels measuring less than 2 mm proximally and less than 0.5 mm distally as they course toward the hila. Bronchial arteries are classified as orthotopic if they arise between the T5 and T6 vertebral bodies. Ectopic bronchial arteries can originate from alternative locations, such as the aortic arch or subclavian artery. Bronchial arterial system is the main source of bleeding in 90% of the cases of massive hemoptysis, followed by the pulmonary arteries (5%), and the non-bronchial systemic arteries (5%). MDCT offers detailed anatomical information on bronchial vasculature. Identification of prominent and/or tortuous bronchial arteries is a fundamental goal of MDCT in patients with hemoptysis. The causes of bronchial artery dilatation can be divided into five broad categories as follows: (1) Congenital pulmonary artery anomaly; (2) Acquired intrinsic pulmonary artery obstruction; (3) Acquired extrinsic pulmonary artery obstruction; (4) Acute or chronic inflammation (5) Less common causes as bronchial Artery Anomalies. The presence of dilated bronchial arteries in patients with pulmonary hypertension is suggestive of chronic thromboembolism. Aim of the work This study aims to evaluate the bronchial arteries regarding their origin, size, number and branching pattern using different Multi-detector CT techniques as CT pulmonary angiography, CT aortography and contrast enhanced CT in cases of suspected chronic pulmonary thromboembolism and hemoptysis cases. Patients and methods Patients : This cross sectional analytical study included 139 patients of cases suspected chronic pulmonary embolism and cases of hemoptysis. Results In this study MSCT was done as described; 121 cases underwent CTPA, 15 cases did aortic angiography and 3 cases did CECT. The technique choice was according to the clinical presentation and clinician request. CTPA detected bronchial arteries in (108 out of 121 cases) with detection rate of 89.2%, 47 cases (38.9%) of which were dilated and 61 cases (50.4%) were normal. CTA detected bronchial arteries in all 15 cases with detection rate of 100%, 14 cases (93.3%) of which were dilated and 1 case (7.7%) was normal. CECT detected bronchial arteries in all 3 cases with detection rate of 100%, all of which were dilated however, this was based on a limited sample size of only 3 cases. Out of the referred 37 cases of chronic thromboembolism, 25 cases (67.6%) had dilated bronchial arteries only, 6 (16.2%) cases have dilated bronchial arteries and other collaterals. In this study 67 cases of hemoptysis were evaluated. Dilated bronchial arteries found in 32 out of 67 cases (47.8%), indicating that near half of the hemoptysis cases show dilated bronchial arteries. Normal bronchial arteries identified in 27 out of 67 cases (40.3%). Non-visualized bronchial arteries seen in 8 out of 67 cases (11.9%) (Figs. 4, 6, 7). The most common cause of hemoptysis was inflammatory in 23 out of 67 cases (34.3%), 22 out of 67 cases (32.8%) no definite cause was detected by the CT study. Acute thromboembolism was the cause in 10 cases (14.9%). Conclusion Bronchial arteries can be effectively visualized using various CT imaging modalities, including CTPA, CECT and CTA. Bronchial arteries are valuable in distinguishing pulmonary hypertension secondary to CPTE from other etiologies, such as idiopathic pulmonary arterial hypertension. In patients presenting with hemoptysis, bronchial arteries represent a major source of bleeding. MDCT allows for non-invasive assessment of bronchial artery dilatation, as well as localization and quantification, thereby reducing the reliance on conventional invasive angiography in detection of bronchial arteries.