Cudkowicz et al, 1951

8/6/2019 Cudkowicz et al, 1951

1/17

Thorax (1951),6, 343.

OBSERVATIONSONTHENORMAL ANATOMY OFTHEBRONCHIALARTERIES

BY

L. CUDKOWICZ*AND J. B. ARMSTRONGFrom the Department of Medicine, Postgraduate Medical School of London

(RECEIVEDFOR PUBLICATIONOCTOBER16 , 195 1)

The existence ofsystemicarteries to the lungs has been known for manycenturies. Ruysch (1732)claimed to be the first to have describedthe bronchialarteries, but Galen had alreadydone so in the second century A.D.

During the nineteenthcentury the anatomy of the bronchialarteries was studiedin detail and their possiblefunctionconsidered.Reisseisenand von Soemmering(1808)definedthe bronchialarteries as " vasa nutritiva" of the lungs,and showedthat they accompanied the bronchi. Le Fort (1858)showed that the bronchialarteries continuealongthe bronchialtree as far as the respiratorybronchioli. VonLuschka (1863)drew attentionto the ramificationof thebronchialarteriolesin thebronchialmucosa and suggestedthat the capillariesof the bronchialarteriolescom-municated near the alveolarducts with those derived from the pulmonary arteries.

Virchow (1856)showed that occlusionof a lobarpulmonary artery branch didnot result in necrosis ofthe lobe. He concluded thereforethat the viability of thelobe,didnot depend on the pulmonary artery, but was maintained by the bronchialarteries. Rindfleisch(1878)consideredthe bronchialarteries to be end arteries.Kuttner (1878),by dye injectionsin rabbitlungs,showed that the terminalbranchesof the pulmonary arteries were nowhere in communication withvesselsof a similarcalibre, and concluded that communication between the pulmonary artery bed andthe bronchialarteries, if it existed, must be capillary only. Zuckerkandl (1881and 1883)demonstrated that the bronchial arteries suppliedthe visceralpleurainman, and thoughtthat the capillariesof the pulmonary and bronchialarteries werein communication.

Miller (1947),at the beginningof this century, describedthe course of thebronchialarteries. He showed that they ran from the aorta to the main bronchiand followedthesedistally to the hila. There theydividedand continued in thewallsof the bronchi as far as the alveolarducts. From the fibroustunic, in whichan arterial plexuswa s formed, smallbranches penetratedthe muscle layer to reachthe tunicapropriaof the bronchus and then continued to run in the long axis of thebronchus.

Millerdid not thinkthat theproblem of anastomosis between the two circulationshad been adequately

studiedby previous workers, and contended that the use of a

* In receiptof a grant from the Medical Research Council.2B

group.bmj.comon June 28, 2011 - Published by thorax.bmj.comDownloaded from
http://group.bmj.com/http://group.bmj.com/http://group.bmj.com/http://thorax.bmj.com/http://thorax.bmj.com/http://group.bmj.com/http://thorax.bmj.com/


2/17

L. CUDKOWICZand J. B. ARMSTRONG

fluid injection medium capableof traversingthe capillarybeds led to erroneousobservations.With the aid of a viscid injection mass he showed that com-munications existedonly between the venous capillaries of the two systems. Thecapillariesfrom the bronchialarteriesconstituteda source for the pulmonary veinsand joined the pulmonary venulesas additional venous radicles. Hence thepulmonary veinsconveyed a proportion of systemicvenous blood to the left auricle.He injectedBerlinblue in gelatin at a pressureof 110 mm. of mercury into thevesselsof the dog's lungs and found that on injecting(a) the pulmonary artery,leavingthe pulmonary veinspatent,the bronchialarteries did not fill; (b) the pul-monary veins, with the pulmonary artery patent, there was slight filling of thebronchialarteries; (c) the pulmonary artery with the pulmonary veins clamped,there was slight fillingof the bronchialarteries; (d) the pulmonary veinswith the

pulmonary artery clamped, the bronchialarteries filled completely. In addition(e) the pulmonary veinswere injectedalone until a free flow issuedfrom the pulmo-nary artery. The pulmonary veinswere then clamped and a solutionof gelatincon-tainingvermiliongranuleswas forcedinto the pulmonary artery. The pulmonaryveinsand the bronchialarteries remained blue. The pulmonary arterybecame red.

Millerconcluded from these studiesthat the injectionof the bronchialarteriesvia the pulmonary arteriesbecomes possibleonly if thepulmonary veinsare occluded,that is, as a result of back pressurealong thosevenous radicleswhich participateinthe formation of the pulmonary veins. Karsner and Ash (1912)showed that as longas a definite pressurewas maintained in both the pulmonary artery bed and the

bronchialarterial circuit little admixture of the injectionmedia would take place.Reduction of the pressurein one system to zero might bringabout penetrationbythe oppositesystem. They also demonstrated that experimental emboli did not pro-duce necrosisof the affectedlungsegments as long as the bronchial arteries werepatent.

Berry, Brailsford, and Daly (1931)and Daly (1935-6)confirmed Miller'sobservationand also found that the bronchialarteries suppliedboth vasa vasorumto the pulmonary arteriesand branches to all pulmonary nerves and to the lymphaticstructuresin the lungs,the hila, and at the carina. Mathes, Holman, and Reichert(1930,1932)used a radio-opaque injectionmass to studythe bronchial arteries inthe

lungsof a dog,and reached the same conclusionas Miller. They agreed that thepul-monary arteries were end arteries and did not communicate with vesselsof similarcalibrederivedfrom the bronchial arteries. Berry (1935)injectedthe lungsof still-born infantswith 40% barium sulphatein 2.5% gelatinand confirmed the findingsof Miller.

The normal anatomy of the bronchialarteries appears thereforewellestablished,in particulartheir mode of distributionto the bronchi and the ancillarydistributionto otherlung structures.

In the presentstudythe anatomy of the bronchial arteries is examined once morein normal human post-mortem material,usinga new technique. Particularattentionhas been paidto the intra-pulmonarydistributionof the bronchial arteries in normallungsas a necessarypreliminaryto later studies of the changes in the bronchialarteriesfound in disease.

344



3/17

NORMAL ANATOMY OF THE BRONCHIALARTERIES

MATERIAL

The lungs examined in this series were normal in structure and showed no evidenceof histologicallesions in the lung vessels,the alveoli, or bronchial tree, and the radio-graphic appearances of the bronchial arteries were, therefore,assumed to show normalconfigurations. In 10 preparationsthe vascular patterns, obtained with the aid of aradio-opaque injectionmass, showed uniformityand similarity of detail. It is there-fore thought reasonableto use these 10 studies as criteria of normality. Histologicalsectionshave been taken of all injectedlungsand were studied in conjunctionwith theradiologicalobservations.Detailsof the cases from which the material was obtainedare shown in Table I.

TABLEICAUSESOF DEATHIN PATIENTS WHOSELuNGSWEREINVESTIGATED

Case Ag e Sex Diagnosisat Time of Death Lungs Injected1 61 M. Chronic leukaemia R. and L.2 45 M. Chronic nephritis R. and L.3 49 M. Coronary thrombosis R. and L.4 43 M. Cerebralglioma R. and L.5 70 F. Carcinoma of cervix R. and L.6 46 M. Tabeticvesicalcrisis (suddendeath after

catheterization) R. and L.7 66 M. Post-operativelyfollowingpartial gas-

trectomy fo r chronic pepticulcer R. and L.8 61 M. Carcinoma of rightmiddle lobebronchus;

cerebralmetastases L. lung normal9 57 F. Carcinoma of rightupper lobe bronchus L. lung normal10 53 M. Carcinoma of right lower lobebronchus L. lung normal

METHODSTh e bronchialarteries were outlinedby a contrast medium injectedinto the aorta

under pressuresequal to the mean systolicpressure recorded during life. Radiographswere taken as soon as the injectionmedium was thoughtto have cooled and hardenedsufficientlyto prevent leakagefrom smallvesselsduringthe manipulations of the speci-men. Antero-posteriorviews and lateral views with the hilum facingeither the tube orthe plate were used. It was found that all the injectedarteries were shown equallywellin each of thesepositions.

InjectionMedium.-The injectionmedium was that used by Dr. J. P. Shillingford(1950)at the London Hospitalfor his work on the coronary circulation. The solutionconsistedof an equal amount of bismuth oxychloridecream* and 50% gelatinin water.It flowed evenlyat temperatures between 25 and 350C. and filled vesselsof 60 y indiameter and above. At no time did penetration into the capillarybed obscure thevascularrelationships.

* Th e bismuth oxychloride cream wa s prepared by adding 1,000ml. of concentrated hydro-chloricacid to 515 g. of bismuth oxycarbonate; 1,300ml. of distilled water were added to thesolutionand the whole filtered into approximately 30 litres of London tap water. Th e filtrationinto the tap water precipitatedthe bismuth oxychloride cream and rendered the solutionneutral.After the precipitatehad settled the clear neutralsupematant fluid was decanted.The settled wetprecipitateof the bismuth oxychloridecream was stirred well,and 250 ml. of this were mixed withan equal volume of 50% gelatinin water beforeuse.

345



4/17

L. CUDKOWICZ and J. B. ARMSTRONG

Apparatus.-The apparatus used throughout this work is shown in Fig. X. A 6-litrebottle with a low-setoutflow was used as a pressure reservoir. A stopcock was incor-porated in one of the two glass tubes in the cork, through which air was pumped by anattached sphygmomanometer bulb. A length of pressure tubing connected the reservoirwith a glass tube in the cork of a 500 ml. flask containing the injection medium. Asecond lengthof tubing allowed interruptionof the flow of the medium without losingthe head of pressure in the reservoir,the volume of which wa s sufficient to maintain thepressure for some minutes when the injectionmedium was flowing. A mercury mano-meter was incorporated in the circuit between the reservoirand the flask.

STOP-COCKocCI

INSUFFLATION CANNULAB U B SIX LITRE CHAMBER

50 0 CONTAININGBUTHXYICHLORIDE

FIG.X. Diagram of the apparatus.

TECHNIQUEIn five cases injectionswere attempted with the lungs in situi. The left commoncarotid

artery wa s cannulated, the aorta was tied off above the heart and diaphragm and tourni-quets were appliedto the arms. The medium was injectedat 400 C. after flushingthethoracicaorta with warm saline. In all five cases the bronchial arteries failed to fill,possiblybecause the medium in the aorta cooled rapidlyand solidified.

In the technique finally adopted the pericardium wa s incised and the heart wasremoved. The posteriorpericardialmembrane was opened to expose the oesophagusan d the descending aorta. Both structureswere divided just above the diaphragm andthe aorta at that level was clamped. The lungs,one at a time, were then gentlyeverted

across the midline to expose theparavertebral

gutter. The parietalpleura in that positionand about tw o inches away from the vertebralbodies was incised longitudinallyfromthe first rib down as far as the diaphragm. The intercostal arterieswere thereby severedand their proximal stumps, with the overlying pleura,were reflectedmediallyacross theanteriorlongitudinal ligaments.The same procedure was carried out on the oppositeside. Thus, the whole mediastinum was freedof it s posteriorattachments. The tracheawas cut across opposite the first rib and the distal portion was clamped. The subclavianarteries were severed at the same level and the proximal ends ligated. The commoncarotidarteries were divided and the thoraciccontents,less the heart, removed in bulk.The right commoncarotid artery and all free stumps of the intercostalarteries, whichcould be easilyidentifiedin the freeedge of the parietalpleura,were securelyligated. Thewhole preparation was suspended in a warm water bath at a temperature of 400C. The

left common carotid artery wa s cannulated and warm saline was injectedthroughthe

cannula at the systolic pressure of the patientin life. All other intercostalstumps which

346



5/17


6/17

L. CUDKOWICZand J. B. ARMSTRONG

diaphragmatic surfacemay be called " basal pleural branches " and the vesselsinthe fissures" right" or " left obliquefissurebranches " and " right horizontalfissurebranches " respectively.

On many occasionswe observed one branch of the hilarpleuralvesselsextend-ing to the apical pleura, particularlywhere apical lesions apparently led to anincreasein its size. We suggestthat this branch might be called the" apical pleuralbranch" (Fig. 1). The otherpleuralbranches were less constant and it is thereforeprobably simplerto retain for thesethe non-specificnomenclature already referredto.

True Bronchial Arteries.-The systemicarteries to the lungsentered the hilum toform a communicating arc round the main bronchi from which the bronchialarterialdivisionsradiatedalongthe major bronchi. They adhered closelyto the bronchialtree and appeared to followthe same course (Figs. 1 and 2). They bifurcatedwith

the bronchiand sent two divisionsalongeach bronchus,one on each side of its wall,which oftentendedto form an intercommunicatingnetwork in the fibrouscoat of thebronchus.Smaller twigspenetratedthe bronchialwallsand appeared as a similarnetwork in the submucosa. In the present10 normal cases no pre-capillaryana-stomoses couldbe demonstrated between the bronchialand pulmonary arteries.

By the arrangement outlinedthe bronchialarteries tended on the radiographtooutlinethe positionof the bronchialtree (Fig. 3). In view of this constant patternof the bronchialarteries in normal lungsit might be convenientto use the acceptednomenclature of the bronchialtree (ThoracicSociety,1950)for the main bronchialarterial divisions(Fig. 4). The arterial divisionsas seen in a left and a right lateralview are outlinedby Figs. 5 and 6 respectively. This nomenclature should be appliedto the set of vesselsaccompanying the respectivebronchus. A finer divisionofnomenclature would not serve a usefulpurpose. The vascularconfigurationscanbe identifiedwith ease in normal lungsas the generalpatternremains constant. Notracingsof the pleuraldivisionshave been made, for reasons alreadyindicated,butthe constancy of the apicalpleuralbranch is thoughtto meritemphasisonc e more.

HISTOLOGICALSTUDIESOF THE NORMALBRONCHIALARTERIESFo r the purpose of histologicalstudythe injectedlungswere inflatedvia the trachea

with 10% formol saline at a pressure of about 25 mm. of mercury and suspendedin thesame solutionfo r 48 hours. Blocks were, as a rule, taken from (a) hilar lymph nodes,(b) vagus nerve near the hilum,(c) pulmonary artery at the hilum,(d) main bronchi,(e ) broncho-vascular bundles at random and about three inchesfrom hilum,(f) peripheralvisceralpleura,includingthe apex, (g) areas of interest as revealed by radiographs,and(h) random lung sections.

The sectionswere stainedroutinelywith haematoxylinand eosin. The bismuth-filledarteriesfixedwell and the bismuth cream adhered firmlyto the vesselwallsand remainedin the lumen as a homogeneous white mass. Under the microscopethe mass appearedas coarse black granulesin the vessellumen and made the identificationof the bronchialarteries in the lung substance easy. The pulmonary arteryan d pulmonary veins remained,of course, uninjectedand showed no evidence of the bismuth granulesin their lumina.

RESULTSLymph Nodes.-In all instances bismuth-filled arteries were seen in the capsule

and stroma of lymph nodes. The vesselsin the stroma were smaller than the capsularvesselsand tended to run in the septaseparatingthe lymph follicles. The calibre of

348



7/17

. .~~~~~~~~~FIG.1.-l ateral view (Case3) of right

bronchial tree superimposedonright bronchial arterial pattern.

I =Apical pleuralbranch. Some alveo-lar fogginghas occurred. The hilum facesaway from x-ray tube. About one-thirdof normal size.

FIG. I

.~~~~~~~~~~~~ ~ ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.

....*~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~K ........

FIG. 2.-Lateral view (Case4) of leftbronchial tree superimposedon 4.left bronchialarterial pattern. Therelationshipof thebronchial arteriesto the bronchi,visceralpleura,andlymph node at the left hilum can beseen.

I apical pleural branches; 2= inter- ^lobar septal branches; 3=branch to hilarlymph node; 4=bronchial arteries accom-panying the inferiorlingularbronchus.

Th e hilum facesaway from x-raytube. About one-thirdof normalssze. 2

' 2 3Figs. 1 and 2 are radiographsof pre- _

parations in which the bronchialarterieswere injectedas describedin the text, andth e bronchisubsequentl'filled with aradio-opaque medium.

FIG. 2



8/17

FIG. 3.-The distributionof the bron-chial arteries as seen in an antero-posterior view of a right lung(Case 5). The bronchial treebecomes silhouettedin this view bythe bronchial arteries.

FIG.4.-Radiograph of right and leftlungs (Case 1) with trachea andaorta attachedto show origin ofbronchial arteries from aorta andtheir distributionin th e lungs asseen in an antero-posteriorview.(Distortionof vesselsat hila is dueto ligature around main bronchi.)

LJft ipp"rlo!)-: A- apicalbranch; B =anteriorbranch; C superior lingularbranch; D-inferior lingular branch; E =posterior

branch.Ltct lowr lob',: F lateral branch; G6anterior branch; H- posterior branch;I= apical branch.

Rightuppsr lob


9/17

:. ,:Bj}.:.:..i!I w K::}w ! + :E A ;a - S N N xi r

.rxw st F, | | #s: 5 w >:.!!W..........*. r}: - e'; Q

r5'' { ;S 9 i ijjgFIG.5.-Standard patternof left bron-chial arteries seen in a lateral view

of a left lung (Case 6). (Hilumfacesx-ray tube.)

Upper lob?': A= apica l p leuralbranch; B=posteriorbranch; C= apical branch; D =anterior branch; E = superior lingularbranch; F=inferior lingularbranch; G=annulus.

Lower lobe: H=interlobar pleuralbranch; I=anteriorbranch; K=lateral branch; L=posteriorbranch; M =apical branch.

FIG. 5

A

FIG. 6.-Standard pattern of rightbronchialarteries seen in a lateralview of a right lung (Case 7) .(Hilum facesx-ray tube.)

Upper lobe: A = apical pleural branch; B=apicalbranch; C=posterior branch; D=anteriorbranch.

Middle lobe: E = lateral branch; F = medialbranch; G = interlobar pleural branch;H = annulus.

Lower lob:': I=anterior branch; K=cardiac(medial)branch; L=lateral branch; M=posteriorbranch; N =apical branch.

FIG. 6



10/17

L. CUDKOWICZ an d J. B. ARMSTRONG

the vesselsvarieddirectlywith the size of the lymph nodes. Lymph nodes situatednear the adventitialcoatof a major bronchus receivedtheir bronchial arterial bloodsupply from the vesselssupplyingthe adjacentbronchus (Fig. 7) .

Pulmonary Artery. In seven instancesthe vasa vasorum to the pulmonaryarteriescould be identified,and were seento be wellfilled with bismuth. They werevesselsof more than 100 juin diameter,and seenin the adventitiaof the pulmonaryartery (Fig. 8) .

Vagus.-In five sectionsof the vagi from the regionof the major bronchi well-filled bronchialarterioleswere seenin theperineurium.On two occasionsthe vesselswere seento penetratethe perineurium and to arrange themselvesbetween the nervefibres. No uninjectedarterioleswere visiblenear the nerve trunks,suggestingthere-fore that, in the regionof the lung hila, at least, the bronchialarteries are nutritiveto the pulmonary vago-sympathetic trunks (Fig. 9).

Main Bronchi.-The main bronchi in transversesectionusuallyrevealedthreeto four large bronchialarteries in the peribronchialcoat. Branches from therepassed through the cartilagiious gaps and, after supplying the perichondrium,enteredthe tunicapropriaaossmallbut very obviously injectedvessels. Consider-ablenumbers were seenwithinthe glandularelements and adjacentto the basementmembrane of theciliatedepithelium (Fig. 10).

Smaller Bronchi.- In the smallerbronchi the bronchialarterial arrangementswere the same as in the larger, but the vesselswere naturallyof a smallercalibre.The distributionto the structuresof bronchialwalls was also the same. In theregionof thebronchiolessmallbronchialarterioleswere seenwithinand without thebronchiolarwalls. Those which lay outsidethe wall ran in the fibrousseptum be-tween the accompanying pulmonary arteriole and the bronchiole(Fig. 11). Thepulmonary veinslay in the alveolarseptaa little furtheraway from the bronchioleand were duplicatedat this level.

Lung Parenchyma. Random sectionsof lung from the periphery in the present10 cases showed normal anatomical featuresof the lobules. The capillaries werenot distendedas a result of the large amounts of saline which had been flushedthrough the preparationbeforethe injectionwithbismuth. Well-injectedbronchialarterioleswere seenin the interlobularsepta(Fig. 12). Near the alveolarducts thesmallestbismuth-filledarterioleswere seen adjacentto the mucosa. Their diameterwas probably just over 80 I. The correspondingpulmonary arteriolesand venuleswere larger and free from bismuth. Larger,well-filledbronchialarterioles were,however, visible in the supportingframework of the alveolarepithelium(Fig. 13),and they appeared to enterthe air sacswith strandsof elastic tissue which insinuatedthemselves between the alveolias outgrowthsof the interlobularsepta(Fig. 12).

Pleura.-Sectionsof the visceralpleura showed that the systemicarteries laywithinthe subserosalcoat. Occasional vesselspenetratedthe pleurafrom the under-lying lung. More frequently,and particularlyat the apex, the vesselsappeared toli e entirely in the pleural membrane, which would accord with the macroscopicobservationthat the pleuralarteries of the medial pleura,and the apicalpleuralbranch, coursed from the hilum superficially. All visible arteries in the pleuraofthese normal lungswere fully injected,indicatingthat they were all derived fromthe bronchialarteries(Fig. 14).

352



11/17

_ r K ' Z ' 5 A:,;_ w J* F.. .._.s.;s lo . b *, j

; *r ; ' Qs 1lGj SY .^,r ^, +t_ %,s,

z as ,, _

4r'_b9;',to..X

FIG.7.-Photomicrograph of a trans-verse sectionof a main bronchuswith peri-bronchiallymph node(Case8) . Bronchialarteriescan beseen in (1 ) the stroma of hilarlymph node,(2) capsuleof node,and (3)near vagalbundle.x 7.

FIG.7

FIG.8.-Photomicrograph of a pulmon-ary artery branchnear the hilum(Case8). Bronchialarterioles ofconsiderablediameterwere presentas vasavasorum in the adventitiaofthe pulmonary artery. x 65.

FIG.8



12/17

FiG. 9.-Photomicrograph of vagalnerve bundle near the left hilum(Case10). A bronchialarterioleisvisible in the perineurium. x 105

SC>t%4~

~'b~1,%" ~ - * ' . *

t A > C~~~~~~~~~~~~~~~~~~~aa\~~~~~~~~~~~4

% % % ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ . o

ait.. i y 'S3~~x

Z-0 ~ ~ -

; ~ ~ ~ ~ ~~ p'4kf;' * f , , : g , 4 i ; - e-i f ' ;

/* m'~ ' jj

'j1.t A-'.,~~~~~~~~~~~~~F..

FIG.10.-Photomicrographof a longitudinalsectionof a medium-sized bronchus (Case9) showingbronchialarteriolesin (1)tunicafibrosa,(2)tunicapropria,and (3)submucosa. x 35.



13/17

NORMAL ANATOMY OF THE BRONCHIALARTERIES

v ' O ;s ,

k v

FIG. 11.-Bronchial arteriole (I) near bronchiolus and (I) in supportingtissue of alveolarwall (Case 6) . x 175.

DISCUSSIONIn the presentstudyall bronchialarteriesappeared to originatefrom the aorta,

but no constancy as to their number or their levelof originwas found. This accordswith the analysisof Cauldwell,Siekert,Lininger,and Anson (1948),who, in 150cases, found that the bronchialarteries arose from the aorta in over 90%, that thenumber of the vesselsvariedconsiderably,and that their level of originin nearly80% lay oppositethe fifth and sixth dorsalvertebrae.

The presenttechniquerevealeda constant radiologicalpatternin all the 10 cases.This permittedthenomenclatureof thebronchialtree to be adaptedto thebronchialarterial divisionsoutlined radiographically.In additiona well-marked annulus sur-rounding the main bronchi near the hilum and a constant apicalpleuralbranch wererecognized.

The presenceof bismuth cream in the lumina of the bronchialarteriesmade thedifferentiationof these vesselsfrom pulmonary arteries and veinsin stainedlungsectionscomparativelysimple. The difficultyof differentiatingbetween pulmonaryvenules and arterioleswas wellrecognizedby Brenner (1935). The presentmethodfailed to demonstrate pre-capillaryanastomoses between the bronchialand pul-monary arteries in normal lungs. The absence of flow from the pulmonary

355



14/17

FIG. 12.-Photomicrograph (Case 7) showing bronchialatand (2) and (3) alveolarseptum

i S 9t .* & /

\ *

{ i f 2 v*N# X wb|> s '___s fusv . , w tS*X 8!3 W' { 1. _L

+--< t 7 >6jterioles in (1) interlobularseptum

. x 75.

4* I ...'4

b

*

44

N

91 .3,

4md6-.

.10

"'AlINWIM.

*44W.

t t-I

40 * X F-%4,*' i

"I*_*t 0

.,

1 t &1'%a.

'24*

'A

t .,%*:- _F A

FIFIG.13.-Bronchial arterioles in alveolar walls(Case 4). x 205

* .

*A 06 .:..

fl,.F"..



15/17

NORMAL ANATOMY OF THE BRONCHIAL ARTERIES 357

,~~~~~~~~.~~~~~~~~~~~~k

C-C

FIG. 14.-Photomicrograph (Case 2) of bronchial arterioles in (1) visceralpleura,(2) interlobularseptum, and (3) alveolar wall x 88.

arteries during the preliminary flushingwith saline, and the liberal flow fromthe pulmonary xems, favour Miller's contention that the bronchial capillarybedconstitutesan additionalsource for the pulmonary veins. It would also appear thatthe bronchial artery bed is independent of the pulmonary artery bed in health, andthat pre-capillarycommunications of the two systems are of pathologicalsignificance.

Finally there are numerous bronchial arterioles in the interlobularsepta whichcourse along strandsof elastic tissue to reach the interstitial tissue of the alveoli.These interlobulararterioles are derived,not from the arteries accompanying thebronchi, but from the pleuralarterial system. The arterioles supplying the inter-stitial tissue of thealveolicould be distinguishedfrom the pulmonary arteriolesonlyby their bismuth-filledlumina. It appears,therefore,that the actualframework of thealveolihas its own systemicarterial blood supply.

SUMMARYThe bronchial arteries in 10 normal lungs were injectedwith a radio-opaque

medium and studiedradiologicallyand histologically. The territory of the bronchial

arteries was found to extend to all lung structureswith the exception only of theepithelium of the pulmonary capillaries. No pre-capillaryanastomoses between the



16/17

L. CUDKOWICZand J. B. ARMSTRONGpulmonary and bronchialarteries were found in normal human lungs. A constantradiographicpatternfor the bronchial arteries innormal lungs was demonstrated.The histologicalexamination of the intra-pulmonary distributionof the bronchialarteries indicatedthat the supporting framework of the alveoli receivesits ownindependent arterial blood supply from vesselsof the interlobularsepta,which reachtheair sacsat a directionat rightanglesto the alveolarducts.

Some of the materialin this study has been incorporated in a thesis by L.C. for theM.D. degree and was accepted by the University of London in December, 1950.

Wewish to thank ProfessorJ. McMichael, Dr. J. Crofton, and Dr. C. V. Harrisonfor placingfacilities at our disposal;Dr. B. Lennox for his encouragement; Dr. J. P.Shillingford,of the London Hospital,for details of the injectionmedium; the technicalstaff of the Department of Pathology for cuttingand stainingthe sections; Miss M. S.McAdamfor takingthe radiographs; Mr. C. V. Willmott, F.R.P.S., fo r the photomicro-graphy, and Mr. K. Moreman, A.R.P.S.,for reproducing the radiographs.

REFERENCESBerry,J. L. (1935).Quart.J. exp.Physiol.,24,305.- Brailsford,J. F., and Daly, I. de B. (1931). Proc. roy. Soc.B., 109,214.

Brenner,0. (1935). Arch. intern. Med., 56, 211 , 457 ,724,976 , 1189.Cauldwell,E. W., Siekert,R. G., Lininger,R. E., and Anson, B. J. (1948). Surg.Gynec. Obstet.,

86, 395.Daly, I. de B. (1935-6).Harvey Lect., 31, 235.Galen, C. (1562). Tractat.Frobenianae edit., lib. 6, cap. 3. Basel.

- (1854). Oeuvres de Galien,trans. C. Daremberg, vol. 1, p. 385. Paris.Karsner, H. T, and Ash, J. E. (1912).J. med. Res.,27, 205.Kfuttner,C. (1878). VirchowsArch.,73, 476.Le Fort,L. (1858). " Recherches sur l'Anatomiedu PoumonChez l'Homme." These,Paris.Luschka, H. von. (1863). Die Anatomie des Menschen, vol. 1: Tiubingen.Mathes, M. E., Holman, E., and Reichert,F. L. (1932).J. thorac.Surg.,1, 339.- Reichert,F. L., and Holman, E. (1930).Proc. Soc.exp.Biol., N.Y.,27, 278.

Miller,W. S. (1947). The Lung, 2nd ed., Springfield,Ill.Reisseisen,F. D., and Soemmering, S. T. von (1808). Uber den Ba u De r Lungen. Berlin.Rindfleisch,E. (1878). Handbuch der Gewebelehre,Leipzig,5th ed.Ruysch, F. (1732). Epistolaanatomica,Amsterdam.Shillingford,J. P. (1950).Personalcommunication.Thoracic Society(1950). Thorax,5, 222.Virchow, R. (1856).Gesammelte, Abhandlungen zur wissenschaftlichenMedicin,p. 285. Frankfurt

a.M.Zuckerkandl, E. (1881). Sb.Akad. Wiss.,Wien, Abt. 3, 84, 110.- (1883). Ibid., Abt. 3, 87, 171.

358



17/17

doi: 10.1136/thx.6.4.3431951 6: 343-358Thorax

L. Cudkowicz and J. B. Armstrong Bronchial ArteriesNormal Anatomy of theObservations on the

http://thorax.bmj.com/content/6/4/343.citationfound at:Updated information and services can be

These include:

serviceEmail alerting

right corner of the online article.topcite this article. Sign up in the box at the

Receive free email alerts when new articles

Notes

http://group.bmj.com/group/rights-licensing/permissionsTo request permissions go to:

http://journals.bmj.com/cgi/reprintformTo order reprints go to:

http://group.bmj.com/subscribe/ To subscribe to BMJ go to:

http://thorax.bmj.com/content/6/4/343.citationhttp://group.bmj.com/group/rights-licensing/permissionshttp://group.bmj.com/group/rights-licensing/permissionshttp://journals.bmj.com/cgi/reprintformhttp://journals.bmj.com/cgi/reprintformhttp://group.bmj.com/subscribe/http://group.bmj.com/http://group.bmj.com/http://group.bmj.com/http://thorax.bmj.com/http://thorax.bmj.com/http://group.bmj.com/http://thorax.bmj.com/http://group.bmj.com/subscribe/http://journals.bmj.com/cgi/reprintformhttp://group.bmj.com/group/rights-licensing/permissionshttp://thorax.bmj.com/content/6/4/343.citation

Documents

Cudkowicz et al, 1951