From the Guidelines
The initial management approach for a patient with peribronchial thickening noted on Chest X-ray (CXR) should focus on identifying the underlying cause through clinical correlation and possibly additional testing, with consideration of high-resolution CT scan for further evaluation if initial findings are inconclusive or if symptoms persist 1. The management of peribronchial thickening depends on the underlying etiology, which could range from infectious causes like bronchitis to chronic conditions such as asthma or COPD.
- For infectious causes, treatment typically includes supportive care with hydration, rest, and possibly a course of antibiotics such as amoxicillin or azithromycin if bacterial infection is suspected.
- For asthma-related thickening, bronchodilators like albuterol and inhaled corticosteroids such as fluticasone are recommended.
- Chronic conditions like COPD may require long-term inhaled bronchodilators and corticosteroids, while inflammatory conditions might need systemic steroids like prednisone. Key considerations in management include:
- Clinical correlation to identify the underlying cause
- Use of additional diagnostic tests such as pulmonary function tests or bronchoscopy if necessary
- Follow-up imaging in 4-6 weeks to ensure resolution of findings
- Consideration of high-resolution CT scan for further evaluation if initial findings are inconclusive or if symptoms persist, as it is considered the reference standard for the noninvasive diagnosis of bronchiectasis and interstitial lung disease 1. Peribronchial thickening represents inflammation or fluid in the tissues surrounding the bronchi, appearing as prominent bronchial walls or "tram tracks" on X-ray, and proper management addresses both symptoms and the underlying pathology, prioritizing morbidity, mortality, and quality of life outcomes.
From the Research
Management Approach for Peribronchial Thickening
The management approach for a patient with peribronchial thickening noted on Chest X-ray (CXR) depends on the underlying cause of the thickening.
- Peribronchial thickening can be seen in a wide variety of diseases, including sarcoidosis, pulmonary lymphangitic carcinomatosis, silicosis, and lymphoproliferative disorders 2.
- In patients with asthma, inhaled corticosteroids (ICS) and long-acting inhaled beta(2)-agonists (LABAs) are recommended treatment options 3.
- For patients with chronic obstructive pulmonary disease (COPD), triple therapy with ICS, LABA, and long-acting muscarinic antagonists (LAMA) may reduce rates of moderate-to-severe COPD exacerbations and improve health-related quality of life 4.
- In acute asthma, bronchial wall thickening is considered a radiographic sign, but its presence does not reliably distinguish radiographs of acutely asthmatic from normal individuals 5.
Diagnostic Classification
- Chest CT imaging can assist in formulating a differential diagnosis and directing further diagnostic evaluation for diseases involving the lung peribronchovascular region 6.
- A category approach to peribronchovascular diseases on CT imaging can be integrated with clinical features as part of a multidisciplinary approach for disease diagnosis 6.
- Lung peribronchovascular diseases can appear on CT imaging as diffuse thickening, fibrosis, masses or masslike consolidation, ground-glass or air space consolidation, and cysts 6.