Bronchial artery from aortic arch

Case contributed by Dr Craig Hacking

Presentation

Pleuritic chest pain and bradycardia for 2 days. Known thoracic aortic aneurysm.

Patient Data

Age: 71
Gender: Male
Modality: CT

Aneurysmal ascending aorta measuring 4.8cm in diameter at its root, 4cm at the origin of the brachiocephalic trunk, 3.9cm at the proximal descending aorta, then tapering down to 3.0cm at the level of the carina. An arterial variant is seen, with a right bronchial artery arising from the medial wall of the aortic arch. The thoracic aorta opacifies normally with no filling defects or false lumen seen. Minor partially calcified mural atheroma in the descending aorta.

Although not a dedicated CTCA with beta blockade and GTN, there is a fusiform aneurysm 9 mm in length measuring 5.5 mm in diameter at the bifurcation of the left main coronary artery, extending more into the circumflex artery than the LAD. Calcified atheroma causes mild stenoses of the proximal LAD and proximal circumflex artery. Mixed calcified and non-calcified plaque causing at least moderate stenosis at the origin of the RCA. Coronary artery origins are normal, right dominant circulation. The distal vessels cannot be assessed. Normal heart size. No pericardial effusion.

Bilateral dependent atelectasis. Apart from this the lungs are clear. No pleural effusion or pneumothorax.

Numerous hypodense lesions affecting all segments of the liver of fluid density. Incompletely imaged large paravertebral hypodense lesions are likely renal cysts.

No fractures or suspicious osseous lesions seen.

Conclusion

  • Aneurysmal ascending aorta measuring 4.8cm in diameter at its root. No evidence of dissection in the thoracic aorta or its major branches.
  • Numerous liver lesions and large paravertebral upper abdominal masses consistent with history of polycystic kidney disease.
  • Atheroma at the origin of the RCA is causing least moderate stenosis with calcified mild stenoses in the proximal LAD and proximal LCx. LMCA bifurcation fusiform aneurysm.

 

Case Discussion

In this case, a small variant bronchial artery arises from the aortic arch. The bronchial arteries usually arise from the descending aorta. Other arch variants are seen here.

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Case Information

rID: 37621
Case created: 16th Jun 2015
Last edited: 8th Oct 2016
Systems: Chest, Vascular
Inclusion in quiz mode: Included

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