From the Guidelines
Bronchovascular crowding is a significant radiographic finding that suggests the presence of volume loss or atelectasis in the lung, which can be associated with increased morbidity and mortality, particularly in patients with chronic obstructive lung disease (COPD) 1. The presence of bronchovascular crowding on chest X-rays or CT scans indicates that the normal lung markings, such as bronchi and blood vessels, appear more prominent and closer together than usual. This finding is not a disease itself but rather a sign that suggests the presence of underlying lung pathology. Some key points to consider when evaluating bronchovascular crowding include:
- The finding is often associated with volume loss or atelectasis in the lung, which can be caused by various factors such as obstructive atelectasis, compressive atelectasis, or cicatrization atelectasis 1.
- In patients with COPD, bronchovascular crowding may be associated with increased susceptibility to exacerbations, worse health status, and higher morbidity 1.
- The presence of bronchovascular crowding on CT scans, along with other factors such as lower lung density and thickened bronchial walls, may be associated with increased mortality risk after an acute exacerbation of COPD 1. Therefore, when bronchovascular crowding is identified, it is essential to further investigate the underlying cause and develop a treatment plan that addresses the underlying lung pathology, rather than just the radiographic finding itself 1.
From the Research
Bronchovascular Crowding Significance
- Bronchovascular crowding is a radiological sign that can be associated with various pulmonary conditions, including obstructive lung diseases such as asthma, COPD, and emphysema 2, 3, 4.
- In these conditions, bronchovascular crowding can be a result of increased airway resistance, pulmonary hyperinflation, and high pulmonary dead space, leading to increased work of breathing 4.
- The main goal of mechanical ventilation in patients with bronchovascular crowding is to improve pulmonary gas exchange and to allow for sufficient rest of compromised respiratory muscles to recover from the fatigued state 4.
- Non-invasive positive-pressure ventilation can be an effective treatment option for patients with bronchovascular crowding, especially in COPD patients, as it can shorten the duration of hospitalization and improve prognosis 2, 3.
- However, invasive ventilation may also be required in patients with more severe disease, and the physician must be cautious to avoid complications related to mechanical ventilation, such as excessive dynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsic PEEP or auto-PEEP) 4.
Related Conditions and Treatments
- Bronchodilators, such as long-acting β2-adrenoceptor agonists (LABAs) and long-acting muscarinic acetylcholine receptor antagonists (LAMAs), can be used to optimize bronchodilation in patients with airway disorders such as asthma and COPD 5.
- Fixed-dose combinations of inhaled LABAs and LAMAs, as well as "triple inhalers" containing a combination of bronchodilators and an inhaled corticosteroid, have been developed to improve treatment outcomes 5.
- Everolimus treatment can be complicated by respiratory adverse events, including interstitial lung disease (ILD) and infections, which can be difficult to diagnose and require a thorough diagnostic workup 6.