In bronchial artery embolization performed for massive hemoptysis, the bronchial arteries most commonly arise from which of the following?

• A Right subclavian artery near the thyrocervical trunk
• B Ascending aorta just above the sinotubular junction
• C Descending thoracic aorta at the level of T5 to T6 ✓
• D Right pulmonary artery at its proximal trunk

Explanation

Orthotopic bronchial arteries arise from the descending thoracic aorta, typically between the T5 and T6 vertebral levels, and this is where the operator searches first during embolization for hemoptysis. Aberrant origins such as the aortic arch or subclavian artery do occur, but they are the exception rather than the rule. The pulmonary circulation is a low-pressure system and is not the usual source of massive hemoptysis, which almost always arises from systemic bronchial arteries.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

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