COPD - bronchial collateral circulation

Case contributed by Dr Dinesh Brand

Presentation

Recent infective exacerbation of COPD.

Patient Data

Age: 60
Gender: Male

There is marked enlargement of the right and left bronchial artery. There appears to be a small bronchial arterial aneurysm; a form of aneurysmal dilatation involving a segment of the right or left bronchial artery.

There appears to be calcified atherosclerosis associated with enlarged bronchial artery branches on the right and left.

Bronchial artery enlargement may be seen in the context of chronic inflammatory lesions of the lung parenchyma. Enlarged, tortuous arteries are seen in the mediastinum between T3 and T7.

Case Discussion

Bronchial circulatory dilatation and collateral vessels are a response to chronic pulmonary ischemia and decreased pulmonary blood flow through hypertrophy/enlargement in an effort to maintain blood flow to the affected lung and maintain gas exchange through systemic-pulmonary arterial anastomoses 1.

Walker et al state that angiogenic growth factors such as vascular endothelial growth factor are postulated to promote collateral supply and neovascularity, with proliferation and expansion of the bronchial arteries.

Common inflammatory lung and airway disorders associated with bronchial artery dilatation include tuberculosis and nontuberculous mycobacterial infections, cystic fibrosis and other causes of bronchiectasis, mycetoma, and chronic fungal infections 1.

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Case information

rID: 64257
Published: 15th Nov 2018
Last edited: 16th Nov 2018
System: Chest, Vascular
Inclusion in quiz mode: Included

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