The normal anatomy and variations of the bronchial arteries: evaluation with multidetector computed tomography

Introduction: In this study, we aimed to reveal the normal anatomy and variations of the bronchial arterial system and to determine the sex distribution of these variations by retrospectively reviewing the images of patients who underwent thoracal multidetector computed tomographic angiography for various reasons. Materials and Methods: Multidetector computed tomographic images of a total of 208 patients (151 men; mean age, 59 years) were retrospectively reviewed to assess the normal anatomy and variations of the bronchial arterial system. Results: A total of 531 bronchial arteries (median, 3; minimum, 1; maximum, 5; mean, 2.5) were detected. The number (mean diameter) of the right bronchial arteries were higher than the left bronchial arteries (290 [1.43 mm] and 241 [1.26 mm], respectively; P <.05 for both number and diameter). The mean number (diameter) of the bronchial arteries were higher with men than with women (2.58 [1.45 mm] and 2.47 [1.32 mm], respectively; P < .05 for both number and diameter). The most common (24%) branching pattern was the combination of 1 right intercostal-bronchial trunk and 1 left bronchial artery, and, secondarily (13.46%), the combination of 2 right (1 intercostal-bronchial trunk and 1 bronchial artery) and 1 left bronchial arteries. Seventy-eight ectopic bronchial arteries were detected in 59 cases (28.3%). They most commonly originated from the aortic arch (37.2%), the descending aorta below the level of T6 (35.9%), or the aortic branches (16.7%). The number of right ectopic bronchial arteries was significantly higher than the left ectopic bronchial arteries (50 [64%] vs 28 [36%]; P < .01). The incidence of ectopic bronchial arteries was statistically higher with men versus women (45 [29.8%] vs 14 [24.6%]; P < .05). Conclusion: The origins, numbers, diameters, and courses of the bronchial arteries can vary substantially among individuals. Multidetector computed tomographic angiography enables a detailed road map of the bronchial arterial system to interventional radiologists and thoracic surgeons. (author)