A case of unusual configuration of the right bronchial arteries combined with cryptogenic severe bilateral hypertrophy.

Bronchial arteries commonly originate from thoracic aorta between T5 and T6. Ectopic origins from aortic arch, supraortic trunks and their branches, coronary arteries, and even abdominal aorta have been described in the literature. In some circumstances, such as pulmonary artery malformations, chronic embolism, or inflammatory diseases of the lung, the bronchial arteries become hypertrophied and eventually could be the only supply of pulmonary circulation. Here, we describe a case of an elderly man who presented an unusual pattern of bronchial arteries of the right lung combined with severe bilateral hypertrophy of bronchial vessels. In the right side, one bronchial artery originated from the descendent aorta and anastomosed with a branch descending from the thyrocervical trunk, which, in turn, received in its path an anastomosis from the superior intercostal artery. The right lung also received a second bronchial artery that originated from the internal thoracic artery. This arterial configuration could be explained by the persistence of precostal longitudinal anastomoses during the embrionary development. Left bronchial arteries presented an orthotopic origin from the descending aorta. Arteries of both sides were very hypertrophic and tortuous resembling major aortopulmonary collateral arteries described in patients with pulmonary atresia. Hypertrophy was more pronounced in the right lung with some segments presenting a lumen diameter of 10 mm. No cardiac or vascular malformations that could explain the hypertrophy of bronchial arteries were observed. In contrast, both lungs showed clear signs of chronic inflammation and fibrosis that could be the cause of bronchial artery hypertrophy.