Non-bronchial Systemic Arteries In Hemoptysis:A Radiological Correlation Study

Background and objective:Non-bronchial systemic artery（NBSA）is crucial in the development of hemoptysis.Effective embolization of NBSA plays an important role in the interventional management of hemoptysis and lowers short-term recurrence.We performed this retrospective study in order to understand the relationship between NBSA and age,gender,underlying diseases and locations of lesion,to investigate the genesis,distribution and supply pattern of NBSAs,and to offer possible evidence of targeting culpable NBSAs during angiography.Materials and methods:Digital subtraction angiography（DSA）and computed tomography（CT）data of 471 hemoptysis cases involving NBSA from Jan 1^th,2013 to Dec 31^th,2017 were retrospectively analyzed.NBSA incidence in different age group,gender and left and right lung was calculated.Origin and distribution pattern of NBSAs as well as their correlation with the location and nature of underlying diseases were also investigated.Results:Altogether 280 male and 191 female patients ranging from seven to 88 years old（54.1±15.3 years old）were included.There were 1203 pathological NBSAs identified,the incidence was 67.3%.No statistical difference of NBSA incidence was found among different age and sex,or between left and right lungs（P>0.05）.The most common causes for hemoptysis-inducing NBSAs were bronchiectasis（50.47%）and tuberculosis（12.53%）.Whereas patients with destroyed lung（s）and congenital heart disease had the largest amount of NBSAs,which was 4.19±2.83 and 3.33±2.51 respectively.The number of NBSAs was statistically different among underlying diseases（P<0.05）.Pairwise comparison showed that destroyed lung（s）had significantly more NBSAs than alveolar hemorrhage/pneumonia and lung cancer.Nevertheless,the difference disappeared when lesions were more diffuse（involved more than one lobe）.Common origins of NSBAs were inferior phrenic arteries（369）,internal thoracic arteries（304）,proper esophageal artery（128）,posterior intercostal arteries（143）,lateral thoracic arteries（85）,costocervical trunks（48）and thyrocervical trunks（25）.NBSAs with the same origin had different distribution pattern among different lobes（P<0.05）,and constituent ratios of NBSAs among lobes were also significantly different（P<0.05）.NBSAs from internal thoracic arteries,thyrocervical trunks,lateral thoracic arteries and posterior intercostal arteries were usually located in the upper lobes,especially those from the costocervical trunks.NBSAs from inferior phrenic arteries and proper esophageal artery were mostly located in the lower lobes,with proper esophageal artery being the most common one.NBSAs from inferior phrenic arteries,proper esophageal artery and internal thoracic arteries were commonly seen in the middle/lingular lobe.Conclusion:NBSAs are pathological hemodynamic compensatory arteries caused mainly by acquired conditions.Different age,sex and side of lung had no clear effects on the number of NBSAs.The fundamental reason for NBSAs to supply blood to the lung is pulmonary hypoxia and hypoperfusion.Pleural thickening and adhesion promote this process.Therefore,there were significant differences in the number of NBSAs caused by different underlying diseases,with lung damage and congenital heart disease being the most NBSA-inducing diseases.The distribution of NBSAs was closely related to the original blood vessel and lesion site and followed the"principle of proximity"to a large extent.When the primary lesion in the lung was adjacent to the blood supply area of certain original artery,it might participate in the blood supply of the lesion and be responsible for the hemoptysis.