Radiological features of enlarged bronchial arteries.

Changes in the radiological appearances of the hilar region of the lungs may indicate that the pulmonary blood supply is not normal. In atresia of the pulmonary valve, the pulmonary arteries may be absent, but more often they are small and may be supplied or supplemented by anomalous vessels. Then blood reaches the lungs mainly by the bronchial arteries or by other collaterals and there is little flow through the diminutive pulmonary arteries. We wish to describe certain features of the X-ray films-both with intravenous injection of opaque substances and without this help-features that indicate an abnormal blood supply to the lungs by enlarged bronchial and collateral arteries. After a short account of present knowledge of the subject we shall discuss some teleradiograms with these unusual appearances. We shall then describe the angiocardiograms of some cases which we believe show that these collateral vessels are largely responsible for the abnormal vascular pattern. We shall first consider two patients with anomalous pulmonary blood supply, one with a clinical diagnosis of truncus arteriosus and the other with pulmonary atresia or possibly truncus arteriosus where the diagnosis was supported by direct observation at operation. We shall then describe five other patients in whom the presence of hypertrophied bronchial arteries and pulmonary atresia was confirmed post-mortem.