From the Guidelines
For a patient with mild prominence of bronchovascular markings in the retrocardiac space and degenerative spinal and left AC joint changes, clinical correlation is recommended to determine if further evaluation is necessary, with consideration of a baseline chest X-ray as suggested by the British Thoracic Society guideline for bronchiectasis in adults 1. The mild bronchovascular prominence may represent normal variation or early inflammatory changes, and should be assessed in context of the patient's symptoms such as cough, shortness of breath, or fever. If the patient is symptomatic, a pulmonary consultation and possibly additional imaging such as a high-resolution CT scan of the chest may be warranted, as recommended by the ACR Appropriateness Criteria for chronic dyspnea of noncardiovascular origin 1. For the degenerative joint changes, conservative management is typically the first approach, including:
- Over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily with food) for pain relief
- Physical therapy focusing on strengthening and range of motion exercises to help manage joint discomfort
- Heat or cold therapy and activity modification may also provide symptomatic relief If pain persists despite these measures, prescription-strength NSAIDs, corticosteroid injections, or referral to orthopedics may be considered. These recommendations balance addressing potential respiratory concerns while managing the more common degenerative changes that are likely causing discomfort.
From the Research
Patient Findings
- The patient has mild prominence of bronchovascular markings in the retrocardiac space
- Normal cardiothoracic ratio
- Degenerative changes in the spine and left AC joint
Recommended Course of Action
- The patient's findings of mild prominence of bronchovascular markings in the retrocardiac space may be indicative of a condition such as primary pulmonary hypertension or bronchial asthma, as seen in studies 2, 3, 4
- The presence of degenerative changes in the spine and left AC joint may be unrelated to the pulmonary findings, but should be considered in the overall management of the patient
- Further evaluation, such as high-resolution computed tomography (HRCT) or pulmonary function tests, may be necessary to determine the underlying cause of the bronchovascular markings and to guide treatment 5, 3
- The patient's normal cardiothoracic ratio suggests that there is no significant cardiomegaly or pulmonary edema, but this should be monitored in follow-up evaluations 6
Potential Diagnoses
- Primary pulmonary hypertension: characterized by increased bronchovascular markings on chest radiograph and patchy distribution of tracer on lung scan 4
- Bronchial asthma: may show abnormal radiologic findings such as bronchial wall thickening, bronchiectasis, emphysema, and mosaic pattern of lung attenuation on HRCT 3
- Chronic bronchitis and emphysema: may show evidence of over-inflation, pulmonary hypertension, and attenuation of medium-sized pulmonary vessels on chest radiograph 6