Peribronchial Cuffing

What is peribronchial cuffing?

Peribronchial cuffing is a sign seen on X-rays and CTs of the chest.  This means that the bronchus which carries air to and from the lungs becomes thickened.   We use this term more on X-rays then we do on CT.

On X-ray, the bronchus has the appearance of a donut.  The center is filled with air and the periphery or wall is thickened.  Peribronchial cuffing refers to the larger bronchi since we can not usually see the smaller ones on X-ray.

What causes peribronchial cuffing?

Peribronchial cuffing has many causes.   Most commonly we see this with inflamed bronchi like that from bronchitis, asthma or infection.  We can see peribronchial cuffing when there is fluid in the walls of the bronchi.  This can occur from heart failure of other causes of edema in the lungs.

What does peribronchial cuffing look like on xray?

Peribronchial cuffing on chest X-rays is often seen in the central lungs near the hila.  The hila are where the bronchi enter the lungs and are the largest.  They become smaller as you head out to the periphery of the lungs.

Peribronchial cuffing will look like thickened bronchi.  This is often a finding based on the experience of the radiologist.  There is no measurement used.  Often the bronchi will look like donuts when seen on end.

Peribronchial cuffing may be associated with other findings on imaging of the chest.  This will help with the diagnosis.  For example, peribronchial cuffing from heart failure will often show edema in the lungs and peribronchial thickening.

Is peribronchial thickening same as peribronchial cuffing?

It can be because both essentially mean the same thing.  Peribronchial cuffing is used more frequently on X-rays whereas peribronchial thickening is more often used on CT.  Both terms are interchangeable.

What are peribronchial cuffing symptoms?

The symptoms are related to the underlying condition which caused the finding on the X-ray.  There are many diagnosis which are possible when we see peribronchial cuffing.   If the peribronchial cuffing is related to viral infection then we may have cough and fever.  Edema which leads to peribronchial cuffing may be seen in someone with known heart failure.

Common causes of peribronchial cuffing

In kids, peribronchial cuffing can be seen with asthma or viral infections like RSV.  In adults, we commonly see peribronchial cuffing with asthma, bronchitis, cystic fibrosis, and smoking related diseases.  Rarely, a focally thickened bronchus can be from cancer.

Is peribronchial cuffing dangerous?

The underlying condition causing the peribronchial cuffing will indicate if the finding is dangerous.  The danger of the finding will depend much more on how the patient is doing and what the diagnosis is causing the abnormality.

Peribronchial cuffing treatment

The underlying cause of the peribronchial cuffing will determine the treatment.  For example, if the peribronchial cuffing is caused by a viral infection, then supportive measures and time are all that are needed.

If the finding is caused by asthma or other inflammatory disorder of the bronchi, then those conditions must be treated in order for the finding to improve on X-ray.

If the finding is caused by edema, then the underlying cause needs to be treated.  If there is heart failure causing edema, then that must be treated in order for the finding to resolve.

If the underlying cause of the peribronchial cuffing is chronic and permanent then the finding will not go away.  If the patient is asymptomatic then no treatment may be needed.

Peribronchial cuffing: summary

Peribronchial cuffing is therefore a finding on imaging.  This does not indicate a specific diagnosis or treatment.  There can be many causes with bronchial inflammation and edema being the most common.

It is therefore important to have additional information about the patient to come to the correct diagnosis.  There are often other findings on imaging or additional information about the patient which help us reach a diagnosis.

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