From the Guidelines
Prominence of central bronchovascular markings on a chest X-ray is a significant finding that suggests increased blood flow or fluid in the central lung vessels and airways, often associated with conditions such as pulmonary hypertension, heart failure, or fluid overload states. This finding can be seen in several conditions, including heart failure, where the left ventricle cannot effectively pump blood, causing fluid backup in the lungs that appears as prominent central vessels 1. Pulmonary hypertension causes enlargement of pulmonary arteries, as evidenced by a study by Miniati et al, which found that chest radiography has a high sensitivity (96.9%) and specificity (99.1%) for the detection of moderate to severe PH 1. Other causes include inflammatory lung diseases, infections, or vascular abnormalities. Key findings of PH on chest radiography include:
- Enlargement of the central pulmonary arteries, with or without rapid tapering (pruning)
- Right heart chamber enlargement
- A measurement of the right descending PA >15 mm in women (>16 mm in men) at the hilum on a posterior anterior view has good sensitivity, specificity, and accuracy for PH 1. This finding requires clinical correlation and often additional imaging such as CT scans for definitive diagnosis. The radiologist will typically comment on whether the prominence is due to vascular congestion, airway thickening, or both, which helps narrow down the differential diagnosis. If you notice this finding on a chest X-ray report, it should prompt evaluation of the patient's cardiac and pulmonary status, as a normal chest radiograph does not exclude PH, and further imaging evaluation should be pursued if there are persistent unexplained symptoms such as dyspnea or risk factors for PH 1.
From the Research
Prominence of Central Bronchovascular Markings on Chest X-Ray
The prominence of central bronchovascular markings on a chest x-ray can be an indicator of various conditions.
- It is associated with pulmonary edema, as seen in studies 2, 3, where the accumulation of water in the lung leads to increased density and prominence of these markings.
- In the context of pulmonary hypertension, the prominence of central bronchovascular markings can be related to the widening of the pulmonary artery and increased vascular engorgement, as discussed in studies 4, 5, 6.
- The use of computed tomography (CT) scans can provide more detailed information about the lung structure and function, allowing for a more accurate assessment of the condition, as shown in studies 2, 4, 3, 5, 6.
- Quantitative CT analysis can also be used to assess lung water and density, providing objective measurements that can be correlated with clinical parameters, as demonstrated in study 3.
- The combination of imaging techniques, such as echocardiography and chest CT, can improve the diagnostic accuracy of pulmonary hypertension, as seen in study 5.