CTICasesBronchial Artery Origin Mimicking Aortic Intimal Injury
Imaging findings
In a trauma CT, a small density or focal thickening is seen along the medial aspect of the aortic arch, which was initially called an acute aortic intimal injury and led to stent placement. A subsequent incidental case demonstrates the identical appearance on a non-trauma CT: a small vessel arising from the anterior medial aorta that courses inferiorly and connects to the bronchial artery, clearly identified as a bronchial artery origin in that region. The sagittal view confirms the vessel courses inferiorly, confirming its identity as a bronchial artery taking origin from an unusually superior aortic location.
Key takeaways
A bronchial artery arising from the superior or medial aortic surface near the arch can produce a small nodular density or focal aortic wall thickening on CT that mimics an aortic intimal injury, particularly in the trauma setting where there is a high pre-test probability for aortic injury. Recognizing this normal variant is important to avoid unnecessary aortic stent placement. The diagnostic clue is tracing the structure distally to confirm it is a vessel coursing toward the bronchi rather than a true intimal flap. Comparison of trauma and incidental non-trauma cases reinforces this learning.
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