bronchial artery

The bronchial arteries are the major supply of high-pressure oxygenated blood to the supporting structures of the lung, including the pulmonary arteries, yet they are responsible for only 1% of the lung blood flow overall.

Bronchial artery anatomy is variable, most commonly classified according to Cauldwell classification. A classic pattern of two left and a one right main bronchial arteries is found in ~70% of patients.

Summary

• location: posterior mediastinum, in close association with aorta and bronchi
• origin and termination: thoracic aorta (left); common intercostobronchial trunk (right); terminates at capillary plexi of respiratory bronchioles
• branches and supply: variable
• relations: frequently 

Gross anatomy

The bronchial arteries arise from their parent vessels at the T3-T8 levels, most commonly between T5-T6 level (~70%; range 64-80%) where it is termed an orthopic origin . There are most commonly 3 main bronchial arteries, one right and two left. In addition, there are often additional smaller bronchial arteries arising from the descending thoracic aorta .

They are small caliber arteries, with a diameter of 1.5 mm at the origin, tapering down to approximately 0.5 mm at the pulmonary hila level .

The main bronchial arteries course into the pulmonary hila, branching down to the level of the respiratory bronchioles . Proximally, the left bronchial artery passes to the left of the esophagus, while the right bronchial artery may pass to the right or left of the esophagus . Their small branches form a network of arteries running along the external bronchial surface, with penetrating branches to supply the submucosal arterial network and sometimes a subpleural pulmonary capillary plexus .

Left bronchial arteries

There are usually two left bronchial arteries that arise directly from the anteromedial thoracic aorta :

• superior left bronchial artery: arises from the aorta near the level of the aortic arch, lateral to the carina, and posterior to the left main bronchus
• inferior left bronchial artery: arises from the aorta parallel to the superior artery, but inferior to the left main bronchus

Right bronchial artery

The right bronchial artery has a common origin with a posterior intercostal artery called the intercostobronchial trunk (ICBT), and arises from the right anteromedial aspect of the thoracic aorta .

Supply

• trachea and bronchi
• lymph nodes
• visceral pleura (jointly with pulmonary arterial supply )
• pericardium
• esophagus (middle-third)
• posterior mediastinum
• vagus nerve
• vaso vasorum of the aorta, pulmonary trunk and pulmonary vein

Variant anatomy

Origin

Ectopic origin is present in ~20% (range 8.3-35%) of patients and is defined when they arise from the aorta outside of the level from superior endplate of T5 to inferior endplate of T6 .

The bronchial arteries may arise from a wide range of arteries including :

• aortic arch
• internal thoracic artery
• thyrocervical trunk
• subclavian artery
• coronary arteries

Ostium

Although most commonly arising from the anteromedial aspect of the descending aorta (superomedial aspect aortic arch), the origin may also be located at :

• anterolateral aorta
• posteromedial aorta
• posterolateral aorta (rare)

Branching patterns

• common bronchial artery trunk (i.e. for both left and right bronchial arteries)
• single bronchial artery bilaterally (i.e. one left and one right)
• single bronchial artery on the left and two bronchial arteries on the right (one ICBT)
• left bronchial artery less commonly has its origin from an ICBT

Related pathology

• hemoptysis
• bronchial artery enlargement
• bronchial arterial aneurysm
• broncho-arterial ratio

Siehe auch:

• Embolisation Bronchialarterien
• Truncus intercostobronchialis
• bronchial artery bleeding

und weiter:

• Hampton hump