Bronchial circulation observed in clinical radiology
Suzuki, K.
Nihon Kyobu Shikkan Gakkai Zasshi 26(4): 328-333
1988
ISSN/ISBN: 0301-1542 PMID: 3221570 Document Number: 324655
In bronchial arteriography, magnification radiography is essential for obtaining detailed findings of the bronchial vasculature in the affected lung. The author carried out magnification bronchial arteriographies in 640 patients and investigated these cases in detail. The origin and anatomical formations of the bronchial artery in Japanese subjects ae considerably different from those reported by Caudwell et at., whose report is frequently quoted. This may be due to racial differences. In addition to the main feeder, the other feeding artery may often supply the lesion through the branch from the different origin or anastomosis from other systemic arteries. The radiologist performing interventional angiography should pay special attention to the esophageal branches, because they branch from the bronchial artery and can occasionally cause lethal esophageal complications such as ulcer or fistula after BAI. Increased bronchial circulation and hypervascularization of the bronchial artery is generally seen in some conditions of decreased pulmonary perfusion or proliferation of the interstitial tissues. It is more evident in the granulomatous tissues of chronic inflammation and in the poorly differentiated carcinoma which has abundant stroma. When perfusion of both pulmonary and bronchial arterial is interrupted, the tissue becomes necrotic, frequently with cavity formation. Active pulmonary tuberculosis, bronchiectasis, organizing pneumonia and lung abcess show marked dilation and hypervascularization of the bronchial artery as well as B-P shunts are often observed in such a case. Tumor vasculatures of lung cancer varys corresponding to th manner of extension of the tumor and anatomical structures where the tumor is growing. Squamous cell carcinoma generally shows encasement of the feeding artery or peripheral distribution of the tumor vessels. In the bronchio-alveolar type of adenocarcinoma, the alveolar septa is preserved intact, so the branches of the pulmonary artery distribute throughout the lesion as feeding vessels. In this type, bronchial arteriography reveals the lesion to be avascular. In proportion to the growth of tumor stroma, the bronchial artery becomes a feeder of the lesion. The feeding artery enters into the central portion of the lesion without encasement, and distributes abundant neoplastic vessels toward the periphery of the tumor. Small radiating B-P shunts from the fine networks of the tumor vessels to the peripherals are often observed, being compatible with adenocarcinoma. Undifferentiated carcinoma shows marked hypervascularity and diffuse distribution of the tumor vessels throughout the lesion. In conclusion, bronchial arteriography is a valuable diagnostic procedure for evaluation of the pulmonary diseases as well as therapeutic procedures.