E2142. Cardiovascular and Pulmonary Causes of Bronchial Artery Hypertrophy
  1. Vinay Kandula; duPont Hospital for Children
  2. Achala Donuru; Hospitals of University of Pennsylvania
The bronchial arteries provide systemic blood supply to the trachea, bronchi, bronchial branches, esophagus, and visceral pleura. Normal bronchial arteries are very small, measuring less than 1.5 mm at their origin and are often not visible on CT. The bronchial arteries hypertrophy in response to decreased pulmonary blood flow. The focus of this educational exhibit is to present a pictorial review of cardiovascular and pulmonary causes of bronchial artery hypertrophy. Patients with bronchial artery hypertrophy are often asymptomatic, but may have massive hemoptysis. Bronchial artery interventions can be used successfully in the treatment of hemoptysis.

Educational Goals / Teaching Points
Various causes of bronchial artery hypertrophy will be discussed including congenital diseases (Tetralogy of Fallot, pulmonary atresia, anomalous left coronary artery arising from the pulmonary artery, repaired transposition of great arteries, truncus arteriosus, double-outlet right ventricle), acquired conditions (bronchiectasis, cystic fibrosis, tuberculosis and chronic fungal infections like aspergilloma), malignancy (lung cancer), vascular (hereditary hemorrhagic telangiectasia after treatment, Takayasu arteritis), infiltrative conditions (fibrosing mediastinitis), and pulmonary hypertension (primary or secondary to chronic thromboembolism).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Bronchial artery malformation manifests at multidetector CT as a tortuous and dilated bronchial artery, often with focal aneurysms. Bronchial angiography is used to confirm the diagnosis and also is therapeutic in patients who require nonparticulate embolization.

Radiologists must be aware of the normal anatomy of the bronchial arteries and common variants. They should recognize a patient with bronchial artery hypertrophy and try to look for an underlying cause.