History
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.
Diagnosis
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.
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).
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.
Comments
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.