64-detector row CT evaluation of bronchial and non-bronchial systemic arteries in life-threatening haemoptysis

Abstract

Objective: To retrospectively evaluate the depiction of bronchial and non-bronchial systemic arteries with 64-detector row CT in patients undergoing endovascular treatment for life-threatening haemoptysis.

Methods: 64-detector row helical CT and conventional angiography of the thorax were performed in 28 patients (25 males, 3 females; age range, 18-65 years; mean age, 40 years) with life-threatening haemoptysis. CT images were analysed to identify abnormal bronchial and non-bronchial systemic arteries and also to localise them in two planes.

Results: Using multidetector CT (MDCT), 43 bronchial arteries were identified on the right side and 46 on the left side. 89% of the right bronchial arteries originated from the right intercostobronchial arteries. A common trunk of origin of the right and left bronchial artery was noted in 46% of cases. 23 non-bronchial systemic arteries were noted on the right side and 41 on the left side. Pleural thickening >3 mm was confirmed to be a good predictor of non-bronchial systemic supply. An internal mammary artery diameter of >3 mm and an inferior phrenic artery diameter of >2 mm were sensitive indicators for non-bronchial systemic supply.

Conclusion: MDCT is a good investigation tool for evaluating life-threatening haemoptysis as it confirms the disease process, identifies the origin and ostial position of bronchial arteries, detects non-bronchial systemic arteries and acts as a roadmap for percutaneous transcatheter embolisation.

Figure 1

Maximal pleural thickening is measured in the region of pathology. A pleural thickness >3 mm is significant with increased risk of non-bronchial systemic artery supply. This patient has a pleural thickness of 12.5 mm and hence a diligent search was made for these arteries. Pleural thickening (black arrow) is associated with a tuberculous cavity (white arrow) in this patient.

Figure 2

Usage of the z-axis reference level in coronal maximum intensity projection reconstruction. The carina, left main bronchus or the vertebral body level may be used as references for the bronchial artery (white arrow) in the z-axis.

Figure 3

Multidetector CT evaluation of bronchial arteries. (a) The tortuous course of a hypertrophied right bronchial artery (large arrow) is shown well in this sagittal maximum intensity projection (MIP) image. A non-bronchial systemic artery (small arrows) arising from the internal mammary artery can also be seen in this patient. (b) Coronal MIP image depicts the typical course of bilateral bronchial arteries (arrows) along the superolateral wall of the bronchi. (c) Three-dimensional shaded surface display takes more time for image processing, but is very useful to show the origin, angulations and proximal course in three dimensions. The arrow points to a hypertrophied right bronchial artery.

Figure 4

Clock-face method of depiction of the ostial position of the bronchial artery in the axial plane. (a) A hypertrophied right bronchial artery (arrow) is noted to originate between the 9 and 10′o clock positions. Any bronchial artery with diameter >1.5 mm is supposed to be hypertrophied. The most common location of the right bronchial artery is shown in yellow on the clock face. (b) The left bronchial artery (arrow) is noted to originate between the 11 and 1′o clock positions. The left bronchial artery is slightly more variable in position and hence is more difficult to hook than the right bronchial artery. The most common location of the left bronchial artery is shown in yellow on the clock face.

Figure 5

Multidetector CT evaluation of non-bronchial systemic arteries. (a) Multiple tortuous intercostal arteries (arrows) are seen in this three-dimensional shaded surface display image in a patient with a tuberculous cavity and associated pleural thickening. (b) Oblique sagittal maximum intensity projection (MIP) image shows a hypertrophied inferior phrenic artery (arrow) in a patient with lung base pathology. (c) Branches arising from the left hepatic artery (arrow) supplying a lesion in the lower lobe of the left lung are noted in this oblique coronal MIP image. (d) Hypertrophied vessel (arrow) arising from the left gastric artery is noted to pass to the base of the left lung in a patient with long-standing tuberculosis of the left lung.