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Air bronchogram refers to the phenomenon of air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white). It is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli. Air bronchograms will not be visible if the bronchi themselves are opacified (e.g. by fluid) and thus indicate patent proximal airways.
Air bronchograms can be seen with several processes:
pulmonary edema: especially with alveolar edema 3
severe interstitial lung disease
neoplasms: bronchioloalveolar carcinoma; pulmonary lymphoma
Air bronchograms that persist for weeks despite appropriate antimicrobial therapy should raise the suspicion of a neoplastic process. CT may be planned in such cases.
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Sonographic air bronchograms arise as a secondary consequence of an extreme perturbation of the air-fluid relationship in the lung parenchyma, in which fluid-filled alveoli act as an excellent acoustic medium and allow visualization of the lung parenchyma. Arborising tubular structures representing the bronchial tree may be visualized which, when patent, appear to contain punctiform-to-linear foci. These structures may remain fixed in position throughout the respiratory cycle or be observed to propagate distally and proximally with inspiration and expiration, respectively. This distinction is important for determining the etiology of the underlying pathology 4:
dynamic air bronchograms move centrifugally with respiration
represent fluid mixed with air inside larger bronchi, which are in continuity with the gas inspired by the patient
indicates a non-retractile consolidation, ruling out resorption atelectasis
the specificity of 94% and a positive predictive value of 97% for pneumonia as the cause of the consolidation
static air bronchograms lack detectable movement
indicate isolated, trapped air, consistent with resorptive atelectasis
Alveolar filling with fluid or cells contrasts with gas in the airways resulting in an air bronchgram.
Consolidation may be acute, or chronic and progressive depending on the cause. Pneumonia is typically acute, resolving within six weeks, however failure to resolve may indicate chronic progressive disease such as adenocarcinoma or lymphoma.
History and etymology
The term air bronchogram was coined by Ben Felson (1913-1988) 5.
- 1. Reed JC. Chest radiology, plain film patterns and differential diagnoses. Mosby. (1997) ISBN:0815171226. Read it at Google Books - Find it at Amazon
- 2. Wong JS, Weisbrod GL, Chamberlain D et-al. Bronchioloalveolar carcinoma and the air bronchogram sign: a new pathologic explanation. J Thorac Imaging. 1994;9 (3): 141-4. - Pubmed citation
- 3. Khan AN, Al-Jahdali H, Al-Ghanem S et-al. Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient. Ann Thorac Med. 2009;4 (3): 149-57. doi:10.4103/1817-1737.53349 - Free text at pubmed - Pubmed citation
- 4. Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. (2009) Chest. 135 (6): 1421-1425. doi:10.1378/chest.08-2281 - Pubmed
- 5. Benjamin Felson. Chest Roentgenology. (1973)