Citation, DOI & article data
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 one right main bronchial arteries is found in ~70% of patients.
- 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
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 orthotopic origin 5. 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 7.
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 6.
The main bronchial arteries course into the pulmonary hila, branching down to the level of the respiratory bronchioles 7. 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 8. 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 7.
Left bronchial arteries
There are usually two left bronchial arteries that arise directly from the anteromedial thoracic aorta 8:
- 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 8.
- trachea and bronchi
- lymph nodes
- visceral pleura (jointly with pulmonary arterial supply 7)
- esophagus (middle-third)
- posterior mediastinum
- vagus nerve
- vaso vasorum of the aorta, pulmonary trunk and pulmonary vein
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 1,5.
The bronchial arteries may arise from a wide range of arteries including 1,5:
Although most commonly arising from the anteromedial aspect of the descending aorta (superomedial aspect aortic arch), the origin may also be located at 8:
- anterolateral aorta
- posteromedial aorta
- posterolateral aorta (rare)
- 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
- 1. Yoon W, Kim JK, Kim YH et-al. Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review. Radiographics. 2002;22 (6): 1395-409. doi:10.1148/rg.226015180 - Pubmed citation
- 2. Burke CT, Mauro MA. Bronchial artery embolization. Semin Intervent Radiol. 2004;21 (1): 43-8. doi:10.1055/s-2004-831404 - Free text at pubmed - Pubmed citation
- 3. Sopko DR, Smith TP. Bronchial artery embolization for hemoptysis. Semin Intervent Radiol. 2011;28 (01): 48-62. doi:10.1055/s-0031-1273940 - Free text at pubmed - Pubmed citation
- 4. Chung MJ, Lee JH, Lee KS et-al. Bronchial and nonbronchial systemic arteries in patients with hemoptysis: depiction on MDCT angiography. AJR Am J Roentgenol. 2006;186 (3): 649-55. doi:10.2214/AJR.04.1961 - Pubmed citation
- 5. Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S et-al. Bronchial arteries: anatomy, function, hypertrophy, and anomalies. Radiographics. 2015;35 (1): 32-49. doi:10.1148/rg.351140089 - Pubmed citation
- 6. Monroe EJ, Pierce DB, Ingraham CR, Johnson GE, Shivaram GM, Valji K. An Interventionalist's Guide to Hemoptysis in Cystic Fibrosis. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (2): 624-641. doi:10.1148/rg.2018170122 - Pubmed
- 7. Standring S. Chapter 54 - Pleura, lungs, trachea and bronchi. In: Gray's Anatomy. (2015). 953-969. ISBN: 9780702052309
- 8. Esparza-Hernández CN, Ramírez-González JM, Cuéllar-Lozano RA, Morales-Avalos R, González-Arocha CS, Martínez-González B, Quiroga-Garza A, Pinales-Razo R, Elizondo-Riojas G, Elizondo-Omaña RE, Guzmán-López S. Morphological Analysis of Bronchial Arteries and Variants with Computed Tomography Angiography. (2017) BioMed research international. 2017: 9785896. doi:10.1155/2017/9785896 - Pubmed
- 8. Yener Ö, Türkvatan A, Yüce G, Yener AÜ. The normal anatomy and variations of the bronchial arteries: evaluation with multidetector computed tomography. (2015) Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes. 66 (1): 44-52. doi:10.1016/j.carj.2014.07.001 - Pubmed
- 9. Ichiro Hasegawa, Phillip M. Boiselle, Hiroto Hatabu. Bronchial Artery Dilatation on MDCT Scans of Patients with Acute Pulmonary Embolism: Comparison with Chronic or Recurrent Pulmonary Embolism. (2012) American Journal of Roentgenology. 182 (1): 67-72. doi:10.2214/ajr.182.1.1820067 - Pubmed