Evaluation of the bronchial arteries: normal findings, hypertrophy and embolization in patients with hemoptysis

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Abstract

The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. In this review, we provide a simplified imaging approach to the evaluation of the bronchial arteries. We highlight the anatomy and function of the bronchial arteries, typical imaging findings, how to recognize bronchial artery dilatation, and its underlying causes. Contrast-enhanced computer tomography plays a major role in diagnosing bronchial artery enlargement and also improves treatment planning. Bronchial artery embolization has proven to be effective in controlling the potential hazardous hemoptysis.

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Angiogenesis and remodeling of airway vasculature in chronic inflammation.

Michael P. McDonald (2001)

Angiogenesis and microvascular remodeling are known features of chronic inflammatory diseases such as asthma and chronic bronchitis, but the mechanisms and consequences of the changes are just beginning to be elucidated. In a model of chronic airway inflammation produced by Mycoplasma pulmonis infection of the airways of mice or rats, angiogenesis and microvascular remodeling create vessels that mediate leukocyte influx and leak plasma proteins into the airway mucosa. These vascular changes are driven by the immune response to the organisms. Plasma leakage results from gaps between endothelial cells, as well as from increased vascular surface area and probably other changes in the newly formed and remodeled blood vessels. Treatment with long-acting beta2 agonists can reduce but not eliminate the plasma occurring after infection. In addition to the elevated baseline leakage, the remodeled vessels in the airway mucosa are abnormally sensitive to substance P, but not to platelet-activating factor or serotonin, suggesting that the infection leads to a selective upregulation of NK1 receptors on the vasculature. The formation of new vessels and the remodeling of existing vessels are likely to be induced by multiple growth factors, including vascular endothelial growth factor (VEGF) and angiopoietin 1 (Ang1). VEGF increases vascular permeability, but Ang1 has the opposite effect. This feature is consistent with evidence that VEGF and Ang1 play complementary and coordinated roles in vascular growth and remodeling and have powerful effects on vascular function. Regulation of vascular permeability by VEGF and Ang1 may be their most rapid and potent actions in the adult, as these effects can occur independent of their effects on angiogenesis and vascular remodeling. The ability of Ang1 to block plasma leakage without producing angiogenesis may be therapeutically advantageous. Furthermore, because VEGF and Ang1 have additive effects in promoting angiogenesis but opposite effects on vascular permeability, they could be used together to avoid the formation of leaky vessels in therapeutic angiogenesis. Finally, the elucidation of the protective effect of Ang1 on blood vessel leakiness to plasma proteins raises the possibility of a new strategy for reducing airway edema in inflammatory airway diseases such as asthma and chronic bronchitis.

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ALCAPA syndrome: not just a pediatric disease.

Elena Pena, Elsie Nguyen, Naeem Merchant … (2015)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly. There are two types of ALCAPA syndrome: the infant type and the adult type, each of which has different manifestations and outcomes. Infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the 1st year of life. Rarely, ALCAPA syndrome manifests in adults; it may be an important cause of sudden cardiac death. Historically, ALCAPA syndrome was diagnosed at conventional angiography. However, the development of electrogardiographically gated multidetector computed tomographic (CT) angiography and magnetic resonance (MR) imaging enables accurate noninvasive imaging. At MR imaging and multidetector CT angiography, findings include direct visualization of the left coronary artery arising from the main pulmonary artery. Reversed flow from the left coronary artery into the main pulmonary artery may be seen at steady-state free-precession cine and fast cine phase-contrast MR imaging. Because of its ability to assess myocardial viability, which can be used as a prognostic factor to direct the need for surgical repair, MR imaging plays an important role in patient treatment. Restoration of a dual-coronary-artery system is the ideal surgical treatment for ALCAPA syndrome. (c) RSNA, 2009.

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Clinical assessment and management of massive hemoptysis.

Keith Baptiste (2000)

Massive hemoptysis is a potentially lethal condition that deserves to be investigated thoroughly and brought under control promptly. The mortality rate depends mainly on the underlying etiology and the magnitude of bleeding. Although the diagnosis of hemoptysis may be established by chest radiograph, many pathologies may be missed. Because bronchoscopy and computed tomography are complementary, they may indicate pathologies not detectable by chest radiograph. Finding the etiology and site of the hemoptysis is imperative. Urgent bronchoscopy should be performed in unstable patients because it exacts a paramount role in the diagnostic search and therapy. It can be used to facilitate the introduction of balloon-tip catheters into the bleeding bronchus for tamponade of the hemorrhagic artery, protecting de facto the contralateral lung or nonbleeding bronchi from blood aspiration. Endobronchial tamponade should only be used as a temporary measure until a more specific treatment is instituted. In stable patients, computed tomography should be ordered before any bronchoscopic exploration. Surgery was once regarded as the treatment of choice in operable patients with massive hemoptysis. Bronchial artery embolization (BAE) is an excellent nonsurgical alternative; it is proven to be very effective and lacks the mortality and morbidity encountered in surgical interventions. Nevertheless, surgery is recommended in patients with massive hemoptysis caused by thoracic vascular injury, arteriovenous malformation, leaking thoracic aneurysm with bronchial communication, hydatid cyst, and other conditions in which BAE would be inadequate. MEDICAL MANAGEMENT: Conservative medical therapy may suffice in certain conditions, like bronchiectasis, coagulopathies, Goodpasture's syndrome, and acute bronchopulmonary infections. Preparation for other interventions (endobronchial tamponade, BAE, or surgery in eligible candidates) should be undertaken if the bleeding fails to respond to conservative measures. Supportive therapy should be applied vigorously to all patients with massive hemoptysis.

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Author and article information

Contributors

João Almeida:

ORCID: http://orcid.org/0000-0001-6810-5501

joao.manuel.almeida@hotmail.com

Journal

Journal ID (nlm-ta): Insights Imaging

Journal ID (iso-abbrev): Insights Imaging

Title: Insights into Imaging

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 1869-4101

Publication date (Electronic): 19 May 2020

Publication date PMC-release: 19 May 2020

Publication date Collection: December 2020

Volume: 11

Electronic Location Identifier: 70

Affiliations

GRID grid.415225.5, ISNI 0000 0004 4904 8777, Department of Radiology, , Hospital de Santa Marta, ; Rua de Santa Marta, 1169-024 Lisbon, Portugal

Author information

João Almeida http://orcid.org/0000-0001-6810-5501

Article

Publisher ID: 877

DOI: 10.1186/s13244-020-00877-4

PMC ID: 7237606

PubMed ID: 32430593

SO-VID: 938d11b9-fcc1-46d5-bad2-4e268b0413d8

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 9 March 2020

Date accepted : 21 April 2020

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ScienceOpen disciplines: Radiology & Imaging

Keywords: bronchial arteries,hemoptysis,embolization,computer tomography,angiography

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ScienceOpen disciplines: Radiology & Imaging

Keywords: bronchial arteries, hemoptysis, embolization, computer tomography, angiography

Evaluation of the bronchial arteries: normal findings, hypertrophy and embolization in patients with hemoptysis

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Probing cerebral hemodynamics with BOLD fMRI

Most cited references 45

Angiogenesis and remodeling of airway vasculature in chronic inflammation.

ALCAPA syndrome: not just a pediatric disease.

Clinical assessment and management of massive hemoptysis.

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