Right bronchial artery malformation communicating with the pulmonary vein

Hai Li, RT1; Jvya Cao, MD1; Pengyun Cheng, MD2; Xinglong Liu, MD2

1Department of Radiology, Mianchi County People’s Hospital, Henan, P. R. China

2 Siemens Healthineers, China

A 19-year-old male patient had had a sudden onset of coughing and hemoptysis, with fresh blood four hours earlier. He reported suffering from neither fever, shortness of breath, chest pain nor sleep hyperhidrosis. A native CT chest examination, performed in a local hospital, revealed a suspicious pneumonia. It was suggested that he should undergo antibiotic treatment and a follow-up. The patient came to our hospital inquiring as to the reason for his hemoptysis. A CT chest scan was performed for further evaluation.

CT images showed two right bronchial arteries (RBA), originating directly off the proximal descending aorta. The upper one was dilated and tortuous, coursing up to the level of the aortic arch, then turning down along the segmental artery of the right lower lobe and, finally, demonstrating an anomalous communication with the lateral segmental branch of the right pulmonary vein (RPV). The right minor fissure appeared thickened. Multiple patchy areas of ground-glass opacities (GGO) were shown in the bilateral inferior lobes, as well as in the right middle lobe with consolidations, suggesting exudative changes. There were no signs of abnormalities in the pulmonary artery. An RBA malformation communicating with the RPV was diagnosed and the patient was referred to a higher-level hospital for further treatment.

cVRT images and a thin MIP image show a dilated and tortuous RBA, originating off the proximal descending aorta, its course and the anomalous communication with the lateral segmental branch of the RPV.
Courtesy of Department of Radiology, Mianchi County People’s Hospital, Henan, P. R. China

Fig. 1: cVRT images (Figs. 1a, 1b, and 1d) and a thin MIP image (Fig. 1c) show a dilated and tortuous RBA, originating off the proximal descending aorta (dotted arrow), its course and the anomalous communication with the lateral segmental branch of the RPV (arrows).

Coronal and sagittal MPR images of the right and the left lung show the right middle lobe with GGO and consolidations and the bilateral inferior lobes with multiple GGO, suggesting exudative changes. The thickening of the right minor fissure is seen
Courtesy of Department of Radiology, Mianchi County People’s Hospital, Henan, P. R. China

Fig. 2: Coronal MPR (Figs. 2b and 2c) and sagittal MPR images of the right (Fig. 2a) and the left (Fig. 2d) lung show the right middle lobe (dotted arrows) with GGO and consolidations and the bilateral inferior lobes with multiple GGO (arrows), suggesting exudative changes. The thickening of the right minor fissure (Figs. 2a and 2b, arrowheads) is seen.

Bronchial artery malformation (BAM) is a rare congenital or acquired disorder, characterized by an anomalous connection between a bronchial artery and a pulmonary artery or vein, resulting in a left-to-left or left-to-right extracardiac shunt. Acquired causes of BAM are inflammatory or infectious lung diseases, penetrating trauma, and tumor. Patients are often asymptomatic, but the condition may result in massive hemoptysis leading to death. [1] The hemoptysis can be successfully treated by bronchial artery intervention, with a low risk of adverse events. CT imaging helps provide a vascular road map for the interventional radiologist, prior to bronchial artery embolization. In this case, the origin, course, and anomalous communication of the RBA are clearly visualized, providing confident information for diagnosis and treatment planning. An advanced cinematic volume rendering technique (cVRT) is applied to achieve a better 3D perspective with improved depth and shape perceptions, enabling a lifelike demonstration, and ultimately, facilitating communication with the patient and physicians.

Scanner

Scan area

Thorax

Scan mode

Spiral mode, CTA

Scan length

315 mm

Scan direction

Cranio-caudal

Scan time

2.3 s

Tube voltage

100 kV

Effective mAs

103 mAs

Dose modulation

CARE Dose4D

CTDIvol

3.9 mGy

DLP

134.3 mGy*cm

Rotation time

0.33 s

Pitch

1.2

Slice collimation

128 x 0.6 mm

Slice width

0.75 mm

Reconstruction increment

0.5 mm

Reconstruction kernel

I31f, ADMIRE 3

Contrast

370 mg/mL

Volume

60 mL + 40 mL saline

Flow rate

3 mL/s

Start delay

Bolus tracking with 100 HU at the descending aorta + 6 s