What is the significance of peribronchial thickening?

From the Guidelines

Peribronchial thickening is a radiological sign that requires further evaluation to determine the underlying cause, and management should be guided by the most recent and highest quality evidence, prioritizing morbidity, mortality, and quality of life as outcomes. The most recent and highest quality study on this topic is from 2022 1, which provides guidance on the diagnosis of idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis. According to this study, peribronchial thickening can be a feature of various respiratory conditions, including infections, inflammatory disorders, and chronic conditions. Some key points to consider when evaluating peribronchial thickening include:

• The presence of airway-centered fibrosis, which can be a feature of fibrotic hypersensitivity pneumonitis (HP) 1
• The presence of poorly formed noncaseating granulomas, which can be a feature of HP 1
• The presence of peribronchiolar metaplasia, which can be a feature of HP 1
• The presence of bridging fibrosis, which can be a feature of HP, but is not specific to this condition 1 In terms of management, the approach will depend on the underlying cause of the peribronchial thickening. Some possible management strategies include:
• Antibiotics for infections 1
• Bronchodilators and corticosteroids for inflammatory conditions 1
• Other targeted therapies, such as those used to treat HP or idiopathic pulmonary fibrosis 1 It is essential to prioritize morbidity, mortality, and quality of life as outcomes when managing peribronchial thickening, and to use the most recent and highest quality evidence to guide decision-making. For example, a study from 2017 1 found that exacerbations of bronchiectasis are a major determinant of healthcare costs, and that reducing exacerbations is a key target for therapy. Similarly, a study from 2021 1 found that the presence of granulomas can be a helpful feature in diagnosing HP, but that their absence does not rule out this condition. Overall, peribronchial thickening is a complex radiological sign that requires careful evaluation and management to optimize outcomes.

From the Research

Peribronchial Thickening

Peribronchial thickening refers to the thickening of the tissue surrounding the airways in the lungs. This condition can be caused by a variety of factors, including:

• Infections [ 2 ]
• Inflammatory diseases [ 3 ]
• Allergic reactions [ 4 ]
• Environmental exposures [ 5 ]

Causes and Associations

Peribronchial thickening has been associated with several conditions, including:

• Asthma [ 4 ]
• Chronic obstructive pulmonary disease (COPD) [ 4 ]
• Chronic rhinosinusitis [ 5 ]
• Systemic rheumatic diseases [ 3 ]
• Post-infectious bronchiolitis obliterans [ 2 ]

Imaging and Diagnosis

Peribronchial thickening can be visualized using high-resolution computed tomography (HRCT) [ 6 ] [ 3 ] and other imaging techniques. The condition may appear as smooth, nodular, or irregular thickening of the peribronchovascular interstitium [ 6 ].

Clinical Significance

Peribronchial thickening can have significant clinical implications, including:

• Airway obstruction [ 4 ]
• Respiratory symptoms [ 2 ]
• Reduced lung function [ 4 ]
• Increased risk of respiratory complications [ 3 ]