Bronchial Arteries (Rami Bronchiales)

6 Bronchial Arteries (Rami Bronchiales)

D. Hortung, K. Hueper

The bronchial arteries vary in origin, number, and size. They originate directly from the descending thoracic aorta, most commonly between the levels of the T5 and T6 vertebrae. ¹^–¹⁹ They supply the trachea, larger bronchi, and the bronchopulmonary lymph nodes. There are some anastomoses to the pulmonary arteries.¹^,⁹^,²⁰ The anomalies fall within three categories:

– Whereas two bronchial arteries are usually present on the left side, the right side has only one.

– The bronchial arteries arise from the intercostal arteries on the right side and directly from the aorta on the left side.

– The right bronchial branches more often run posterior than anterior to the esophagus.

In rare instances, the bronchial arteries originate from the internal thoracic artery (Fig. 6.7), subclavian artery, supreme intercostal artery, inferior thyroid artery, ascending aorta, abdominal aorta, or the inferior phrenic artery.¹^,²^,⁸^,²¹^,²² Coronary to bronchial anastomoses can result in a coronary steal syndrome.²³ Spinal arteries may be seen at angiography during bronchial artery embolization for hemoptysis and embolization can rarely result in spinal cord ischemia.²⁴

6.1 Bronchial Arteries—Topographic Anatomy

Fig. 6.1 Topographic anatomy of the bronchial arteries. Schematic (corresponds to Fig. 6.4a).

6.2 Two Bronchial Branches (38%)

Fig. 6.2 Right bronchial branch from the third posterior intercostal artery (more seldom fourth or fifth); left bronchial branch directly from the aorta (31%). Schematic.

Fig. 6.3 Both branches directly from the aorta, sometimes with a common trunk (7%). Schematic (a); DSA of the bronchial arteries with the catheter in the ostium of the common trunk of both bronchial branches, anterior view (b); and CT, MIP in the coronal plane; prominent right bronchial artery directly from the aorta (c). 1 Right bronchial artery; 2 common trunk; 3 angiography catheter in the common trunk; 4 left bronchial artery; 5 descending aorta.

6.3 Three Bronchial Branches (44%)

Fig. 6.4 Two left bronchial arteries (39%). The two left arteries originate mostly from the aorta, less frequently from the right posterior intercostal artery III or IV. Schematic.

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