What is it:
Peribronchovascular findings refer to:
Abnormalities located along the bronchovascular bundles,
which consist of bronchi, pulmonary arteries, and accompanying lymphatics.
These findings often reflect:
Airway-adjacent inflammation ,Lymphatic involvement ,Vascular abnormalities , orNeoplastic processes .
Etymology:
Derived from the Greek word peri- (around), bronchos (windpipe), and vasculum (vessel), referring to the structures surrounding the bronchi and blood vessels.
AKA:
Peribronchovascular thickening, Bronchovascular bundle involvement.
How does it appear on each relevant imaging modality:
Chest X-ray:
May show reticulonodular opacities or thickened bronchovascular bundles.
Findings are typically subtle and best seen in the central or hilar regions.
Chest CT:
Parts: Abnormalities along the bronchovascular bundles extending from the hilum to the periphery.Size: Varies from micronodules to larger confluent abnormalities.Shape: Linear or nodular thickening around bronchi and pulmonary vessels.Position:
Predominantly central but may extend into the periphery along vascular and airway branches.
Character:
May present as:
Smooth thickening (e.g., pulmonary edema).
Nodular thickening (e.g., sarcoidosis or lymphangitic carcinomatosis).
Time:
Can be transient (e.g., resolving infections) or progressive (e.g., neoplasms or fibrosis).
PET-CT:
Useful for evaluating metabolic activity, particularly in cases of suspected malignancy or granulomatous disease.
Recommended for abnormalities larger than 7 mm or diffuse nodular patterns.
These findings reflect:
Airway-adjacent pathology:
Inflammation:
Sarcoidosis (perilymphatic nodules).
Hypersensitivity pneumonitis.
Infection:
Tuberculosis (peribronchovascular granulomas).
Fungal infections (e.g., histoplasmosis).
Lymphatic involvement:
Lymphangitic carcinomatosis.
Perilymphatic metastases.
Neoplastic processes:
Differential diagnosis:
Infection:
Tuberculosis (peribronchovascular granulomas).
Fungal infections (e.g., aspergillosis, histoplasmosis).
Viral pneumonia with lymphadenitis.
Inflammation:
Sarcoidosis (nodular thickening).
Hypersensitivity pneumonitis (peribronchovascular involvement).
Neoplasm:
Lymphangitic carcinomatosis (smooth or nodular thickening).
Lymphoma (diffuse or focal peribronchovascular involvement).
Circulatory:
Pulmonary edema (smooth peribronchovascular thickening).
Pulmonary hypertension.
Iatrogenic:
Post-radiotherapy fibrosis or nodularity.
Immune-related:
Eosinophilic granulomatosis with polyangiitis (EGPA).
Recommendations:
Perform high-resolution CT to assess the size, extent, and morphology of peribronchovascular findings.
Consider bronchoscopy with lavage for infectious or inflammatory causes.
Use PET-CT to evaluate for malignancy or active granulomatous processes.
Correlate with clinical history and laboratory studies (e.g., markers for sarcoidosis or lymphoma).
Key points and pearls:
Nodular thickening along bronchovascular bundles is a hallmark of granulomatous diseases like sarcoidosis or lymphangitic spread of cancer.Smooth thickening is more commonly seen in pulmonary edema or lymphatic congestion.Time-dependent changes, including resolution or progression, provide valuable clues to the underlying pathology.
