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Multi–Detector Row CT of Hemoptysis¹

¹ From the Department of Radiology, Hospital Calmette, University Center of Lille, Blvd Jules Leclercq, 59037 Lille, France. Received December 15, 2004; revision requested April 13, 2005 and received June 2; accepted June 3. All authors have no financial relationships to disclose.

View larger version (113K): [in a new window]   Figure 1a.  Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (a) Axial 1-mm-thick CT scan obtained just below the aortic arch (window center, 50 HU; window width, 350 HU) shows enlarged bronchial arteries (arrow) manifesting as avidly enhancing nodules in the paratracheal and retrobronchial regions of the mediastinum. These findings represent the typical appearance of enlarged bronchial arteries on axial images. Although the origins of the bronchial arteries are well depicted on axial images, their further course is very tortuous, and the intrapulmonary direction of the artery can be difficult to ascertain. (b) Coronal thin-section MIP image clearly demonstrates an enlarged intercostobronchial artery (arrows) coursing into the pulmonary parenchyma parallel to the bronchial airways. (c) Coronal thin-section MIP image obtained in a different patient provides a detailed analysis of the entire intrapulmonary course of an intercosto-bronchial artery (arrows). = intracavitary mycetoma. (d) Reformatted image demonstrates how CT angiography can provide anatomic information that is useful for planning subsequent bronchial artery embolization.

 

View larger version (147K): [in a new window]   Figure 1b.  Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (a) Axial 1-mm-thick CT scan obtained just below the aortic arch (window center, 50 HU; window width, 350 HU) shows enlarged bronchial arteries (arrow) manifesting as avidly enhancing nodules in the paratracheal and retrobronchial regions of the mediastinum. These findings represent the typical appearance of enlarged bronchial arteries on axial images. Although the origins of the bronchial arteries are well depicted on axial images, their further course is very tortuous, and the intrapulmonary direction of the artery can be difficult to ascertain. (b) Coronal thin-section MIP image clearly demonstrates an enlarged intercostobronchial artery (arrows) coursing into the pulmonary parenchyma parallel to the bronchial airways. (c) Coronal thin-section MIP image obtained in a different patient provides a detailed analysis of the entire intrapulmonary course of an intercosto-bronchial artery (arrows). = intracavitary mycetoma. (d) Reformatted image demonstrates how CT angiography can provide anatomic information that is useful for planning subsequent bronchial artery embolization.

 

View larger version (162K): [in a new window]   Figure 1c.  Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (a) Axial 1-mm-thick CT scan obtained just below the aortic arch (window center, 50 HU; window width, 350 HU) shows enlarged bronchial arteries (arrow) manifesting as avidly enhancing nodules in the paratracheal and retrobronchial regions of the mediastinum. These findings represent the typical appearance of enlarged bronchial arteries on axial images. Although the origins of the bronchial arteries are well depicted on axial images, their further course is very tortuous, and the intrapulmonary direction of the artery can be difficult to ascertain. (b) Coronal thin-section MIP image clearly demonstrates an enlarged intercostobronchial artery (arrows) coursing into the pulmonary parenchyma parallel to the bronchial airways. (c) Coronal thin-section MIP image obtained in a different patient provides a detailed analysis of the entire intrapulmonary course of an intercosto-bronchial artery (arrows). = intracavitary mycetoma. (d) Reformatted image demonstrates how CT angiography can provide anatomic information that is useful for planning subsequent bronchial artery embolization.

 

View larger version (148K): [in a new window]   Figure 1d.  Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (a) Axial 1-mm-thick CT scan obtained just below the aortic arch (window center, 50 HU; window width, 350 HU) shows enlarged bronchial arteries (arrow) manifesting as avidly enhancing nodules in the paratracheal and retrobronchial regions of the mediastinum. These findings represent the typical appearance of enlarged bronchial arteries on axial images. Although the origins of the bronchial arteries are well depicted on axial images, their further course is very tortuous, and the intrapulmonary direction of the artery can be difficult to ascertain. (b) Coronal thin-section MIP image clearly demonstrates an enlarged intercostobronchial artery (arrows) coursing into the pulmonary parenchyma parallel to the bronchial airways. (c) Coronal thin-section MIP image obtained in a different patient provides a detailed analysis of the entire intrapulmonary course of an intercosto-bronchial artery (arrows). = intracavitary mycetoma. (d) Reformatted image demonstrates how CT angiography can provide anatomic information that is useful for planning subsequent bronchial artery embolization.

 

View larger version (140K): [in a new window]   Figure 2a.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (164K): [in a new window]   Figure 2b.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (151K): [in a new window]   Figure 2c.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (127K): [in a new window]   Figure 2d.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (136K): [in a new window]   Figure 2e.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (114K): [in a new window]   Figure 2f.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (120K): [in a new window]   Figure 2g.  Bronchiectasis in a 51-year-old man who presented with recurrent hemoptysis. (a) Posteroanterior chest radiograph demonstrates severe cystic bronchiectasis in the middle lobe and lingula. (b–g) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis in the right middle lobe and in the lower divisions of the left upper lobe (lingula). (c–g) Thin-section MIP images obtained in the sagittal (c), axial (d), and coronal (e, f ) planes and a 3D volumetric reformatted image (g) depict markedly dilated and tortuous bronchial arteries (arrows in c) and hypertrophic right and left inferior phrenic arteries (arrows in d–g) arising from the abdominal aorta and supplying the areas of bronchiectasis.

 

View larger version (138K): [in a new window]   Figure 3a.  (a) Axial CT scan (1-mm-thick section) obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) in a patient with hemorrhage following an episode of hemoptysis demonstrates bronchial impaction from blood clot (arrow) in a subsegmental branch of the anterior segmental bronchus of the right upper lobe, a finding that helps localize the site of bleeding. (b) Axial CT scan (1-mm-thick section) (window center, –600 HU; window width, 1600 HU) obtained at the level of the right lower lobe in a patient with lymphangioleiomyomatosis who presented with recurrent hemoptysis depicts an air-fluid level in a pulmonary cyst (arrow), a finding that represents intracavitary blood. The consequences of hemoptysis in the lung parenchyma can obscure subtle underlying lesions such as intrabronchial tumors, and follow-up CT performed several weeks after the acute episode is always recommended.

 

View larger version (154K): [in a new window]   Figure 3b.  (a) Axial CT scan (1-mm-thick section) obtained with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) in a patient with hemorrhage following an episode of hemoptysis demonstrates bronchial impaction from blood clot (arrow) in a subsegmental branch of the anterior segmental bronchus of the right upper lobe, a finding that helps localize the site of bleeding. (b) Axial CT scan (1-mm-thick section) (window center, –600 HU; window width, 1600 HU) obtained at the level of the right lower lobe in a patient with lymphangioleiomyomatosis who presented with recurrent hemoptysis depicts an air-fluid level in a pulmonary cyst (arrow), a finding that represents intracavitary blood. The consequences of hemoptysis in the lung parenchyma can obscure subtle underlying lesions such as intrabronchial tumors, and follow-up CT performed several weeks after the acute episode is always recommended.

 

View larger version (141K): [in a new window]   Figure 4a.  Hemorrhage from the intercostobronchial trunk in a 64-year-old man with hemoptysis of 400 mL in 24 hours. (a) Posteroanterior chest radiograph obtained at the time of admission demonstrates no abnormality. (b, c) Axial thoracic CT scans obtained on a 16–detector row scanner with lung parenchymal window settings (window center, –600 HU; window width, 1600 HU) (b) and mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) (c) depict dense material (arrow) within the apical segmental bronchus of the right upper lobe. (d–f ) Sequential arteriograms of the intercostobronchial artery demonstrate immediate filling of the apical segmental bronchus with contrast material (arrow in e and f), a finding that indicates active bleeding from the intercostobronchial trunk into the bronchial tree. Embolization of this artery was successfully performed, with immediate cessation of hemoptysis.

 

View larger version (106K): [in a new window]   Figure 4b.  Hemorrhage from the intercostobronchial trunk in a 64-year-old man with hemoptysis of 400 mL in 24 hours. (a) Posteroanterior chest radiograph obtained at the time of admission demonstrates no abnormality. (b, c) Axial thoracic CT scans obtained on a 16–detector row scanner with lung parenchymal window settings (window center, –600 HU; window width, 1600 HU) (b) and mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) (c) depict dense material (arrow) within the apical segmental bronchus of the right upper lobe. (d–f ) Sequential arteriograms of the intercostobronchial artery demonstrate immediate filling of the apical segmental bronchus with contrast material (arrow in e and f), a finding that indicates active bleeding from the intercostobronchial trunk into the bronchial tree. Embolization of this artery was successfully performed, with immediate cessation of hemoptysis.

 

View larger version (54K): [in a new window]   Figure 4c.  Hemorrhage from the intercostobronchial trunk in a 64-year-old man with hemoptysis of 400 mL in 24 hours. (a) Posteroanterior chest radiograph obtained at the time of admission demonstrates no abnormality. (b, c) Axial thoracic CT scans obtained on a 16–detector row scanner with lung parenchymal window settings (window center, –600 HU; window width, 1600 HU) (b) and mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) (c) depict dense material (arrow) within the apical segmental bronchus of the right upper lobe. (d–f ) Sequential arteriograms of the intercostobronchial artery demonstrate immediate filling of the apical segmental bronchus with contrast material (arrow in e and f), a finding that indicates active bleeding from the intercostobronchial trunk into the bronchial tree. Embolization of this artery was successfully performed, with immediate cessation of hemoptysis.

 

View larger version (97K): [in a new window]   Figure 4d.  Hemorrhage from the intercostobronchial trunk in a 64-year-old man with hemoptysis of 400 mL in 24 hours. (a) Posteroanterior chest radiograph obtained at the time of admission demonstrates no abnormality. (b, c) Axial thoracic CT scans obtained on a 16–detector row scanner with lung parenchymal window settings (window center, –600 HU; window width, 1600 HU) (b) and mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) (c) depict dense material (arrow) within the apical segmental bronchus of the right upper lobe. (d–f ) Sequential arteriograms of the intercostobronchial artery demonstrate immediate filling of the apical segmental bronchus with contrast material (arrow in e and f), a finding that indicates active bleeding from the intercostobronchial trunk into the bronchial tree. Embolization of this artery was successfully performed, with immediate cessation of hemoptysis.

 

View larger version (113K): [in a new window]   Figure 4e.  Hemorrhage from the intercostobronchial trunk in a 64-year-old man with hemoptysis of 400 mL in 24 hours. (a) Posteroanterior chest radiograph obtained at the time of admission demonstrates no abnormality. (b, c) Axial thoracic CT scans obtained on a 16–detector row scanner with lung parenchymal window settings (window center, –600 HU; window width, 1600 HU) (b) and mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) (c) depict dense material (arrow) within the apical segmental bronchus of the right upper lobe. (d–f ) Sequential arteriograms of the intercostobronchial artery demonstrate immediate filling of the apical segmental bronchus with contrast material (arrow in e and f), a finding that indicates active bleeding from the intercostobronchial trunk into the bronchial tree. Embolization of this artery was successfully performed, with immediate cessation of hemoptysis.

 

View larger version (124K): [in a new window]   Figure 4f.  Hemorrhage from the intercostobronchial trunk in a 64-year-old man with hemoptysis of 400 mL in 24 hours. (a) Posteroanterior chest radiograph obtained at the time of admission demonstrates no abnormality. (b, c) Axial thoracic CT scans obtained on a 16–detector row scanner with lung parenchymal window settings (window center, –600 HU; window width, 1600 HU) (b) and mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) (c) depict dense material (arrow) within the apical segmental bronchus of the right upper lobe. (d–f ) Sequential arteriograms of the intercostobronchial artery demonstrate immediate filling of the apical segmental bronchus with contrast material (arrow in e and f), a finding that indicates active bleeding from the intercostobronchial trunk into the bronchial tree. Embolization of this artery was successfully performed, with immediate cessation of hemoptysis.

 

View larger version (157K): [in a new window]   Figure 5a.  Bronchial artery aneurysm in a 37-year-old man with acute hemoptysis of 300 mL in 24 hours. (a) Posteroanterior chest radiograph demonstrates a cavitating mass in the right upper lobe, a finding that subsequently proved to be cavitating reactivation tuberculosis. (b–d) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan (1-mm-thick section) obtained with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts a dense nodular lesion (white arrow) within a necrotic mass in the right upper lobe. Enlarged bronchial arteries (black arrows) can be identified in the mediastinum. (c, d) On thin-section (3-mm) axial (c) and coronal (d) MIP images, the dense nodule (arrow) can be clearly identified as a bronchial artery aneurysm within the necrotic mass. Note the adjacent nodular calcifications in the wall of the mass. (e) Arteriogram shows the aneurysm (arrow) arising from a branch of the intercosto-bronchial artery, which was later successfully embolized.

 

View larger version (87K): [in a new window]   Figure 5b.  Bronchial artery aneurysm in a 37-year-old man with acute hemoptysis of 300 mL in 24 hours. (a) Posteroanterior chest radiograph demonstrates a cavitating mass in the right upper lobe, a finding that subsequently proved to be cavitating reactivation tuberculosis. (b–d) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan (1-mm-thick section) obtained with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts a dense nodular lesion (white arrow) within a necrotic mass in the right upper lobe. Enlarged bronchial arteries (black arrows) can be identified in the mediastinum. (c, d) On thin-section (3-mm) axial (c) and coronal (d) MIP images, the dense nodule (arrow) can be clearly identified as a bronchial artery aneurysm within the necrotic mass. Note the adjacent nodular calcifications in the wall of the mass. (e) Arteriogram shows the aneurysm (arrow) arising from a branch of the intercosto-bronchial artery, which was later successfully embolized.

 

View larger version (97K): [in a new window]   Figure 5c.  Bronchial artery aneurysm in a 37-year-old man with acute hemoptysis of 300 mL in 24 hours. (a) Posteroanterior chest radiograph demonstrates a cavitating mass in the right upper lobe, a finding that subsequently proved to be cavitating reactivation tuberculosis. (b–d) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan (1-mm-thick section) obtained with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts a dense nodular lesion (white arrow) within a necrotic mass in the right upper lobe. Enlarged bronchial arteries (black arrows) can be identified in the mediastinum. (c, d) On thin-section (3-mm) axial (c) and coronal (d) MIP images, the dense nodule (arrow) can be clearly identified as a bronchial artery aneurysm within the necrotic mass. Note the adjacent nodular calcifications in the wall of the mass. (e) Arteriogram shows the aneurysm (arrow) arising from a branch of the intercosto-bronchial artery, which was later successfully embolized.

 

View larger version (139K): [in a new window]   Figure 5d.  Bronchial artery aneurysm in a 37-year-old man with acute hemoptysis of 300 mL in 24 hours. (a) Posteroanterior chest radiograph demonstrates a cavitating mass in the right upper lobe, a finding that subsequently proved to be cavitating reactivation tuberculosis. (b–d) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan (1-mm-thick section) obtained with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts a dense nodular lesion (white arrow) within a necrotic mass in the right upper lobe. Enlarged bronchial arteries (black arrows) can be identified in the mediastinum. (c, d) On thin-section (3-mm) axial (c) and coronal (d) MIP images, the dense nodule (arrow) can be clearly identified as a bronchial artery aneurysm within the necrotic mass. Note the adjacent nodular calcifications in the wall of the mass. (e) Arteriogram shows the aneurysm (arrow) arising from a branch of the intercosto-bronchial artery, which was later successfully embolized.

 

View larger version (156K): [in a new window]   Figure 5e.  Bronchial artery aneurysm in a 37-year-old man with acute hemoptysis of 300 mL in 24 hours. (a) Posteroanterior chest radiograph demonstrates a cavitating mass in the right upper lobe, a finding that subsequently proved to be cavitating reactivation tuberculosis. (b–d) Images from a thoracic CT angiographic study performed with a 16–detector row scanner. (b) Axial CT scan (1-mm-thick section) obtained with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts a dense nodular lesion (white arrow) within a necrotic mass in the right upper lobe. Enlarged bronchial arteries (black arrows) can be identified in the mediastinum. (c, d) On thin-section (3-mm) axial (c) and coronal (d) MIP images, the dense nodule (arrow) can be clearly identified as a bronchial artery aneurysm within the necrotic mass. Note the adjacent nodular calcifications in the wall of the mass. (e) Arteriogram shows the aneurysm (arrow) arising from a branch of the intercosto-bronchial artery, which was later successfully embolized.

 

View larger version (111K): [in a new window]   Figure 6a.  Anomalous bronchial artery anatomy in a patient with acute hemoptysis. Coronal (a) and sagittal (b) thin-section multiplanar reformatted images from thoracic CT angiographic data obtained with a four–detector row scanner show bronchial arteries (arrows) arising from the concavity of the aortic arch. Bronchial arteries have ectopic origins outside the T5 through T6 range in 20% of cases, with the most common origin being the one shown in this case. Such arteries can be difficult to visualize on axial images alone.

 

View larger version (146K): [in a new window]   Figure 6b.  Anomalous bronchial artery anatomy in a patient with acute hemoptysis. Coronal (a) and sagittal (b) thin-section multiplanar reformatted images from thoracic CT angiographic data obtained with a four–detector row scanner show bronchial arteries (arrows) arising from the concavity of the aortic arch. Bronchial arteries have ectopic origins outside the T5 through T6 range in 20% of cases, with the most common origin being the one shown in this case. Such arteries can be difficult to visualize on axial images alone.

 

View larger version (145K): [in a new window]   Figure 7a.  Nonbronchial systemic arteries in a 42-year-old man with acute massive hemoptysis of approximately 300 mL in 24 hours. (a) Initial posteroanterior chest radiograph shows a multiloculated cavitating mass containing multiple air-fluid levels in the right upper lobe, a finding that represents reactivation tuberculosis. (b) Posterior 3D SSD image from thoracic CT angiographic data obtained with a 16–detector row scanner depicts an enlarged right internal mammary artery supplying hypertrophic mediastinal branches (arrows) to an area of the right upper lobe. Selective embolization of these vessels was subsequently performed. (c, d) Sequential arteriograms help confirm the finding in b (arrows). Such abnormally dilated nonbronchial systemic arteries are recruited into the lung parenchyma across transpleural adhesions, usually in the presence of chronic inflammatory disorders, and can be distinguished from ectopic bronchial arteries in that their trajectories do not follow the bronchial airways.

 

View larger version (118K): [in a new window]   Figure 7b.  Nonbronchial systemic arteries in a 42-year-old man with acute massive hemoptysis of approximately 300 mL in 24 hours. (a) Initial posteroanterior chest radiograph shows a multiloculated cavitating mass containing multiple air-fluid levels in the right upper lobe, a finding that represents reactivation tuberculosis. (b) Posterior 3D SSD image from thoracic CT angiographic data obtained with a 16–detector row scanner depicts an enlarged right internal mammary artery supplying hypertrophic mediastinal branches (arrows) to an area of the right upper lobe. Selective embolization of these vessels was subsequently performed. (c, d) Sequential arteriograms help confirm the finding in b (arrows). Such abnormally dilated nonbronchial systemic arteries are recruited into the lung parenchyma across transpleural adhesions, usually in the presence of chronic inflammatory disorders, and can be distinguished from ectopic bronchial arteries in that their trajectories do not follow the bronchial airways.

 

View larger version (124K): [in a new window]   Figure 7c.  Nonbronchial systemic arteries in a 42-year-old man with acute massive hemoptysis of approximately 300 mL in 24 hours. (a) Initial posteroanterior chest radiograph shows a multiloculated cavitating mass containing multiple air-fluid levels in the right upper lobe, a finding that represents reactivation tuberculosis. (b) Posterior 3D SSD image from thoracic CT angiographic data obtained with a 16–detector row scanner depicts an enlarged right internal mammary artery supplying hypertrophic mediastinal branches (arrows) to an area of the right upper lobe. Selective embolization of these vessels was subsequently performed. (c, d) Sequential arteriograms help confirm the finding in b (arrows). Such abnormally dilated nonbronchial systemic arteries are recruited into the lung parenchyma across transpleural adhesions, usually in the presence of chronic inflammatory disorders, and can be distinguished from ectopic bronchial arteries in that their trajectories do not follow the bronchial airways.

 

View larger version (121K): [in a new window]   Figure 7d.  Nonbronchial systemic arteries in a 42-year-old man with acute massive hemoptysis of approximately 300 mL in 24 hours. (a) Initial posteroanterior chest radiograph shows a multiloculated cavitating mass containing multiple air-fluid levels in the right upper lobe, a finding that represents reactivation tuberculosis. (b) Posterior 3D SSD image from thoracic CT angiographic data obtained with a 16–detector row scanner depicts an enlarged right internal mammary artery supplying hypertrophic mediastinal branches (arrows) to an area of the right upper lobe. Selective embolization of these vessels was subsequently performed. (c, d) Sequential arteriograms help confirm the finding in b (arrows). Such abnormally dilated nonbronchial systemic arteries are recruited into the lung parenchyma across transpleural adhesions, usually in the presence of chronic inflammatory disorders, and can be distinguished from ectopic bronchial arteries in that their trajectories do not follow the bronchial airways.

 

View larger version (280K): [in a new window]   Figure 8.  Nonbronchial systemic arteries in a patient with massive hemoptysis. Three-dimensional volumetric reformatted images from thoracic CT angiographic data obtained with a 16–detector row scanner depict transpleural systemic-to-pulmonary anastomoses between distal branches of the internal mammary artery (the musculophrenic and lower anterior intercostal arteries) (arrow) and the pulmonary arteries.

 

View larger version (139K): [in a new window]   Figure 9a.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retrocardiac region.

 

View larger version (155K): [in a new window]   Figure 9b.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retro-cardiac region.

 

View larger version (98K): [in a new window]   Figure 9c.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retro-cardiac region.

 

View larger version (75K): [in a new window]   Figure 9d.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retro-cardiac region.

 

View larger version (76K): [in a new window]   Figure 9e.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retro-cardiac region.

 

View larger version (64K): [in a new window]   Figure 9f.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retro-cardiac region.

 

View larger version (128K): [in a new window]   Figure 9g.  Coronary-bronchial arterial anastomoses in a 49-year-old man with recurrent hemoptysis. (a) Postero-anterior chest radiograph demonstrates severe cystic bronchiectasis in the lingula. (b–g) Images from thoracic CT angiographic data obtained with a four–detector row scanner. (b) Axial 5-mm-thick CT scan obtained at the level of the lingula with parenchymal lung window settings (window center, –600 HU; window width, 1600 HU) demonstrates severe cystic bronchiectasis. (c) Axial 5-mm-thick CT scan obtained at the same level with mediastinal soft-tissue window settings (window center, 50 HU; window width, 350 HU) depicts dilated systemic arteries (arrow) in the region of the pericardial reflection of the retrocardiac area. (d) Axial 5-mm-thick MIP image obtained at a slightly lower level demonstrates a dilated systemic artery (thin arrow) coursing toward the left main coronary artery (thick arrow). An anastomosis with the left anterior descending artery was identified more distally on axial 1-mm-thick images (not shown). The systemic artery was identified as a dilated bronchial artery. (e) Axial 1-mm-thick image obtained at the level of the thoracic inlet depicts dilated nonbronchial systemic arteries (arrow) arising from the left subclavian artery. (f ) Axial 1-mm-thick image obtained at the level of the aortopulmonary window shows dilated bronchial arteries (arrow) in the mediastinum. (g) Three-dimensional volume-rendered reformatted image more clearly depicts the tortuous knot of dilated systemic arteries (arrows) extending from the left subclavian artery to the retro-cardiac region.

 

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