Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Thorax
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
These vessels vary frequently in number and in their mode of origin.
On the right side there is usually one bronchial artery, which arises from the first aortic intercostal artery or by a trunk with the upper left bronchial artery from the descending thoracic aorta.
On the left side, there are generally two arteries, both of which arise from the descending thoracic aorta, one near the origin from the trunk, and the other, the inferior bronchial, lower down.
Each artery is directed to the back part of the corresponding bronchus, along which it runs, dividing and subdividing with the successive bronchial ramifications in the substance of the lung.
The place of origin of the bronchial arteries is subject to considerable variation. The right bronchial artery usually arises from a common stem with the first aortic intercostal (intercostobronchial artery), from the dorsolateral aspect of the aorta (in 78% of cases). The intercostobronchial artery courses either behind the esophagus (67%) or in front of it (in 11%). A right bronchial artery may arise from the aorta (30%) unassociated with an intercostal artery.
The left bronchial arteries, usually two, arise from the ventral surface of the thoracic aorta. In 265 individuals a left bronchial arises in common with a right bronchial.
The artery of the right side has been found to arise singly from the aorta, from the internal thoracic, or from the inferior thyroid.
The bronchial arteries have been seen to arise from the subclavian (Haller).
In one case, the two common trunks, each furnishing a branch to the right and left lungs, descended into the thorax; one trunk arose from the superior intercostal artery (R. Quain).
In some cases the bronchials arise from the inferior surface of the arch instead of from the descending thoracic aorta.
Instances also occur of two distinct bronchial arteries for each lung.
According to Cauldwell, et al. and Swigart, et al., most frequently there are 3 bronchial arteries, 2 left and 1 right. In some specimens, however, there were 2 right bronchial arteries; in such cases the second right bronchial artery coursed either ventral or dorsal to the esophagus. The bronchial artery of the ventral surface of the esophagus usually passed anterior to the bifurcation of the trachea, ultimately reaching the inferior border of the right main bronchus.
In 72% (108 specimens) of 150 cadavers examined, the inferior left bronchial artery gave rise to esophageal arteries. The later vessels were of slightly smaller caliber than the bronchial arteries; they descended a variable distance on the anterior surface of the esophagus. Anastomoses between these esophageal vessels and the ascending branch of esophageal arteries of thoracic aortic origin occurred in many instances. Esophageal arteries from the superior left bronchial artery and superior right bronchial artery, 34.67% and 66.67% (52 and 100 cases, respectively, of 150 specimens), ascended on the anterolateral or posterolateral surface of the esophagus. When a second right bronchial artery was present (as an inferior right bronchial artery), esophageal branches derived therefrom supplied the esophagus, as the bronchial artery passed either ventral or dorsal to the visceral tube. In 14% (21 cases), the inferior right bronchial artery gave rise to a vessel of appreciable size, which coursed a short distance inferiorly on the right anterior surface of the esophagus. Esophageal arteries of this latter origin rarely formed a gross anastomosis with any other esophageal vessel. In fact, the portion of the thoracic esophagus appeared to be less well supplied by esophageal vessels than any other portion of the tube.
In 2.67% of cases (4 specimens) there were three left bronchial arteries: in each instance esophageal arteries arose from the middle left bronchial artery.
From Intercostal Arteries.
Right intercostal arteries were the source of origin of esophageal arteries in 20% of the cases studied (30 of 150 specimens). In a single specimen an esophageal artery arose from a left intercostal artery. Usually an intercostal gave rise to a single esophageal artery; however, in 5 specimens 2 branches arose from the same intercostal artery, and in 3 specimens, 3 esophageal rami were derived from the same intercostal.
From other sources.
Exceptional origins of esophageal arteries occurred on the right side in 3 specimens. The internal thoracic, the costocervical trunk, and the subclavian artery were, each, the source of origin for an esophageal artery. In each instance the vessel coursed downward on the anterior surface of the esophagus.
Arteries to Abdominal Portion of Esophagus.
From Left Gastric Artery.
The arterial supply to the abdominal portion of the esophagus was examined in 150 specimens. In 94.67% of cases (142 specimens), the left gastric artery was a source of of origin for esophageal arteries.
The esophageal arteries originated from the the left gastric, either just proximal to the point where the vessel reverses its direction to supply the lesser curvature of the stomach, or from the area of the bend itself. These esophageal arteries followed the longitudinal axis of the esophagus, supplying predominately the right anterior and posterior surfaces of the esophagus. Throughout the course of the vessels, under the visceral peritoneum of the esophagus, small branches penetrate the muscular tunic of the viscus. No constant relationship of the esophageal arteries to the vagus nerve was noted. Of the 142 specimens in which the left gastric was the source of the esophageal supply, 78% of the cases possessed 1 to 3 esophageal arteries which arose from the left gastric.
From Inferior Phrenic Artery.
The left inferior phrenic artery was a source of origin of esophageal vessels in 56% of cases (84 of 150 specimens). In all but 8% (12 specimens of the 84), a single esophageal branch was given off. The course of these esophageal vessels was similar to that of vessels arising from the left gastric, that is parallel with the longitudinal axis of the esophagus and through the esophageal hiatus of the diaphragm.
Of the 150 cases, esophageal supply originated from the right inferior phrenic artery in 3.33% (5 specimens). In 1 case there was a single branch, distributed to the right posterior surface of the esophagus.
From Accessory Left Hepatic Artery.
In 10% of the cases (15 of 150 specimens), esophageal arteries originated from an accessory left hepatic artery. With the exception of 3 specimens, only 1 esophageal artery in each instance was derived from the above vessel; however, the main branch divided into 2 or 3 twigs when the esophagus was reached.
In 5.56% of the above 15 specimens (8 cases), no esophageal artery arose from the left gastric artery. In the 8 specimens, the supply to the right aspect of the esophagus was derived from the accessory left hepatic artery. The artery divided in such a way as to send rami twigs to both anterior and posterior surfaces.
From Splenic Artery.
In 1.33% of cases (2 specimens), 1 to 2 esophageal arteries originated from the proximal one-third of the splenic artery.
From Celiac Artery.
In a single specimen (0.67%) 1 esophageal artery originated from the celiac axis.
Arteries to Cervical Portion of Esophagus.
The arteries sent to this portion of the esophagus usually originated from the inferior thyroid artery; however, other origins were not infrequent.
From Inferior Thyroid Artery.
In 125 specimens, esophageal arteries originated from the inferior thyroid artery at three separate sites: the ascending portion, the descending portion, and the artery's terminal rami.
The esophageal arteries originated from the terminal branches of the inferior thyroid artery more frequently than from the ascending or descending portions of the vessel. However, the total number of branches from the latter two segments of the inferior thyroid artery exceeded the number derived from the terminal divisons of the parent vessel. Usually a single esophageal branch originated from a segment of the inferior thyroid artery; however, two, but rarely more, esophageal branches arose from the same or different segments of the thyroid artery. Esophageal vessels which originated from the ascending segment of the inferior thyroid artery were not only a larger size, but also descended a greater distance on the anterolateral surface of the esophagus than did similar vessels derived from the terminal branches and the descending portion of the inferior thyroid artery. In the majority of cases, there occurred a tracheoesophageal vessel which arose from the ascending portion of the inferior thyroid artery; it courses downward in company with the recurrent laryngeal nerve into the superior mediastinum. This vessel supplied the trachea and the hilar lymph nodes; additionaly, in several instances, the artery established a gross anastomosis with the right or left superior bronchial artery. Near the level of the suprasternal notch, 1 to 3 branches arose from the tracheoesophageal artery to supply the posterolateral aspect of the esophagus.
With the exception of a single instance, the arteries, after reaching the cervical segments of the esophagus, gave off no ascending branches similar to those seen in the thoracic region. In the exceptional specimen, the esophageal artery, after arising from the superior terminal branch of the inferior thyroid artery, ascended on the anterior aspect of the esophagus to the level of the cricoid cartilage. In another unusual case, in which the the left inferior thyroid artery was absent, the left half of the thyroid gland was supplied by the superior thyroid artery. In the same case the esophagus received its only arterial supply by means of a single branch derived from one of the terminal divisions of the right inferior thyroid artery. There was no demonstrable arterial supply to the left side of the cervical esophagus from any source.
In still another specimen, there was no esophageal supply from either the right or the left inferior thyroid artery; the lower cervical and upper thoracic portions of the esophagus were supplied by rami derived from the bronchial arteries.
Esophageal arteries were found to arise from the ascending segment of the inferior thyroid artery in 36.8% (46 cases) on the right, 51.11% (64 cases) on the left side. As has already been stated, esophageal arteries which arise from the descending portion of the inferior thyroid artery or its terminal branches do not descend for a considerable distance inferiorly on the esophagus. It would appear that unless an artery supplied the esophagus near the jugular notch be demonstrable, it would be well to assume that the esophageal supply is derived either from the descending portion of the inferior thyroid artery, or from one of the latter's terminal branches.
Important too, is the fact that, were the inferior thyroid artery ligated near its terminal branches (as in a previous subtotal thyroidectomy), an adequate arterial supply for the esophagus (near the jugular notch of the sternum) would remain, in the majority of specimens studied - derived from the ascending and descending portions if the inferior thyroid artery, or from one of the latter's terminal branches.
From other Sources.
Although the majority of esophageal arteries took origin from the inferior thyroid artery, there were 13 cases in which the esophageal arteries arose from other sources representing 100 dissections. The addition of 25 dissections, bringing the total of cervical dissections to 125, revealed two cases, on the right side, in which esophageal arteries arose from the ascending pharyngeal artery and the common carotid artery. On case, on the left side, revealed an esophageal artery arising from the left common carotid artery. Thus in 12.8% of cases (16 of 125 cervical dissections), esophageal arteries originated from sources other than the inferior thyroid arteries.
(Authors note: Original text has been slightly edited.) This work on bronchial and esophageal arterial supply come from the work of Cauldwell, Siekert, Lininger and Anson and Swigart, Siekert, Hambley and Anson.
See also Esophageal Arteries and Aorta for Data and References.
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