CTICasesEndobronchial Bronchial Artery and Bronchial-Pulmonary Shunts in MAC
Imaging findings
CT chest shows severe, chronic middle lobe bronchiectasis (consistent with MAC). A macroscopic bronchial artery is seen snaking directly into the lumen of the right middle lobe bronchus. Large hypertrophic bronchial arteries communicate directly with pulmonary arteries, causing flow stasis (smoke phenomenon) on early phase angiography.
Key takeaways
Chronic pulmonary infections (such as Mycobacterium avium complex) can cause severe bronchial hypertrophy. This can lead to endobronchial varices/arteries that mimic tumors on bronchoscopy, and large bronchial-to-pulmonary artery shunts that cause flow stasis artifacts on CT.
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