Spiral CT of bronchial arteries in chronic thromboembolism.
OBJECTIVE
Computed tomography study of bronchial artery anatomy and evaluation of dilatation and tortuousity as indicators for pulmonary hypertension and surgical risk in patients with chronic thromboembolism were performed.


METHODS
We retrospectively reviewed contrast-enhanced, thin section spiral CT scans of 39 patients undergoing pulmonary thromboendarterectomy. Findings were compared with mean pulmonary artery (PA) pressure in all, postoperative mortality in 33, and postoperative CT in 5 patients. Twenty patients without pulmonary hypertension served as controls.


RESULTS
In the pulmonary hypertension group, 50 bronchial arteries were observed in 30 of 39 patients. Their prevalence was significantly higher than in the control group (p < 0.0001). Their proximal diameter measured > or = 1.5 mm in 20 patients (51%); a tortuous course was found in 14 (36%). The correlation between total bronchial artery diameter and mean PA pressure was poor (r = 0.2). Patients with dilated bronchial arteries had a significantly lower risk for postoperative death than patients without (p < 0.05); positive predictive value was 100% and confidence interval 0.79-1.0. Despite normal postoperative PA pressures, bronchial arteries were still visible on follow-up studies.


CONCLUSIONS
The CT depiction of bronchial arteries, dilatation, and tortuousity provides indicators for chronic thromboembolic pulmonary hypertension. Its degree cannot be estimated. Dilated bronchial arteries are a significant predictor for survival of pulmonary thromboendarterectomy.
Klinik für Radiologie, Johannes Gutenberg--Universität Mainz, Germany.
H U
HU
Kauczor
H C
HC
Schwickert
E
E
Mayer
F
F
Schweden
H H
HH
Schild
M
M
Thelen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001981:Bronchial Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D016022:Case-Control Studies; D002908:Chronic Disease; D003287:Contrast Media; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014652:Vascular Diseases / Q000000981:diagnostic imaging
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide