Peri-bronchovascular lesions in chest CT are not necessarily infective: multidisciplinary approach for other differential diagnosis with validation analysis

Abstract Background The peri-bronchovascular interstitium is a system of fibers that surrounds the bronchi and pulmonary arteries. Infection is the most common peri-bronchovascular pathology. Other frequent diseases target the peri-bronchovascular interstitium and express a predilection for lymphatic routes including sarcoid disease, lymphoproliferative disorders, lymphangitis carcinomatosis, and rarely occupational lung diseases. Other pathologies that target the peri-bronchovascular interstitium lacking a peri-lymphatic distribution include cryptogenic organizing pneumonia (COP) and rarely Kaposi’s sarcoma. Aim of the work To achieve a multidisciplinary approach collaborating certain clinical features, laboratory data, and CT findings that can narrow the differential diagnosis of peri-bronchovascular lung diseases to avoid the hazards of lung biopsy. Results This study was planned to include two major steps; the first step included a retrospective prevalence analysis regarding the clinical, radiological, laboratory, and pathological parameters of peri-bronchovascular lung diseases; this included 200 patients during the period from July 2022 to June 2024. The study was performed by three expert consulting radiologists and a single consulting pulmonologist in consensus. Diseases with acute onset were concluded in 51% of patients with either infection, cardiogenic pulmonary edema, or pulmonary alveolar hemorrhage. Diseases with chronic lung fibrosis were concluded in 24% of patients with either progressive massive fibrosis, stage IV sarcoidosis, NSIP, or chronic hypersensitivity pneumonitis. Non-fibrotic diseases with parenchymal CT findings alone were concluded in 15% of patients with either sarcoidosis (stage III), cryptogenic organizing pneumonia (COP), chronic eosinophilic pneumonia (CEP), Wagner granulomatosis, adenocarcinoma, lymphoma, or leukemia. Non-fibrotic diseases with additional extra-parenchymal CT findings were concluded in 10% of patients with either sarcoidosis, lymphoma, leukemia, adenocarcinoma, or Wegner granulomatosis. Statistically significant parameters with P value < 0.05 were used to achieve a diagnostic approach. The second step of this study prospectively included 50 patients with peri-bronchovascular lesions from July 2024 to January 2025 who were subjected to the proposed diagnostic approach. It was proved to be valid by reaching 92–100% sensitivity, 84–99% specificity, 84–98% positive predictive value (PPV), 93–100% negative predictive value (NPV), and 91–99% accuracy . Conclusions A valid multidisciplinary approach is currently proposed for diagnosing peri-bronchovascular lung diseases combining their clinical, HRCT, laboratory, and pathological parameters.