Displaced Bronchus, Lung Abscess and Retrograde Perfusion

¹ Henry R. Landis State Hospital, and the Departments of Medicine, Woman's Medical College and Jefferson Medical College, Philadelphia, Pennsylvania

The bronchus to a portion of lung in the right apex, which contained a large abscess, was found to arise from the right mainstem bronchus just proximal to the right upper lobe bronchus. Because bronchographic studies showed only anterior and posterior segmental branches arising from the right upper lobe bronchus, the abnormally placed bronchus was interpreted as a displaced apical segmental bronchus. During routine pulmonary angiography, the artery to the segment containing the abscess was not visualized. However, it was possible to catheterize this vessel selectively. Retrograde blood flow through the diseased segment was indicated by the demonstration that blood withdrawn from the segmental artery had a high oxygen saturation and by showing reflux of contrast material injected into the vessel. This finding indicates that failure to fill a segmental pulmonary artery during angiography may be caused by retrograde flow in the vessel, as well as by obstruction.