From the Guidelines
Peribronchial thickening is a condition that requires prompt evaluation and treatment to prevent long-term complications, and the most recent and highest quality study 1 suggests that chest CT is the reference standard for the noninvasive diagnosis of bronchiectasis and interstitial lung disease, which are common causes of peribronchial thickening.
Causes of Peribronchial Thickening
Peribronchial thickening refers to the abnormal thickening of the walls surrounding the bronchial airways in the lungs. This condition is typically identified on chest X-rays or CT scans as increased density or thickness around the bronchi. It commonly occurs due to inflammation from infections like bronchitis, pneumonia, or viral respiratory infections. Other causes include asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, allergic reactions, or exposure to irritants.
Diagnosis and Treatment
Treatment depends on the underlying cause - antibiotics for bacterial infections, bronchodilators and corticosteroids for asthma or COPD, or antihistamines for allergic reactions. The thickening occurs because inflammatory cells infiltrate the bronchial walls in response to infection or irritation, causing edema and mucus production. This narrows the airways and can lead to symptoms like cough, wheezing, shortness of breath, or chest tightness.
- Inflammation from infections like bronchitis, pneumonia, or viral respiratory infections
- Asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, allergic reactions, or exposure to irritants
- Relapsing polychondritis, an uncommon autoimmune disorder that causes recurrent inflammation and destruction of cartilage and other connective tissues 1
Management
If you have persistent respiratory symptoms with peribronchial thickening on imaging, follow-up with a pulmonologist is recommended to determine the exact cause and appropriate treatment. According to the European Respiratory Society guidelines 1, improving quality of life and stopping disease progression are key targets for therapy in patients with bronchiectasis, a common cause of peribronchial thickening.
- Follow-up with a pulmonologist to determine the exact cause and appropriate treatment
- Improving quality of life and stopping disease progression are key targets for therapy in patients with bronchiectasis 1
- Chest CT is the reference standard for the noninvasive diagnosis of bronchiectasis and interstitial lung disease 1
From the Research
Peribronchial Thickening
- Peribronchial thickening can be seen in a wide variety of diseases, including sarcoidosis, pulmonary lymphangitic carcinomatosis, silicosis, and lymphoproliferative disorders 2
- It is also associated with hydrostatic pulmonary edema, cryptogenic organizing pneumonia, Kaposi's sarcoma, interstitial pulmonary emphysema, and interstitial hemorrhage 2
- On CT scans, peribronchial thickening can appear as a smooth, nodular, or irregular pattern, depending on the underlying cause 2
Radiographic Features
- Peribronchial thickening was noted on chest radiographs of 14.5% of patients with severe acute respiratory syndrome (SARS) 3
- In pediatric cases of SARS, peribronchial thickening was observed, along with other radiographic findings such as areas of consolidation and pleural effusion 3
- Peribronchial thickening is also a common finding in patients with systemic rheumatic diseases, including rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus 4
CT Findings
- High-resolution computed tomography (HRCT) can detect peribronchial thickening and other bronchial and bronchiolar abnormalities, including bronchiectasis, asthma, and bronchiolitis 5
- The use of intravenous contrast agent and reconstruction kernel can affect bronchial wall thickness measurements on CT scans, with application of contrast agent and softer reconstruction kernel increasing bronchial wall thickness 6