Prevalence and Clinical Implications of Pulmonary Vein Stenosis in Bronchiectasis: A 3D Reconstruction CT Study

Abstract

Background: Recent studies on bronchiectasis have revealed significant structural abnormalities and pathophysiological changes. However, there is limited research focused on pulmonary venous variability and congenital variation. Through our surgical observations, we noted that coarctation of pulmonary veins and atrophied lung volume are relatively common in bronchiectasis patients. Therefore, we conducted a retrospective study to explore pulmonary venous variation and secondary manifestations in bronchiectasis cases, utilizing 3D reconstruction software (Mimics Innovation Suite 21.0, Materialise Dental, Leuven, Belgium) to draw conclusions supported by statistical evidence.

Method: This retrospective study included patients with bronchiectasis and healthy individuals who underwent CT examinations at Beijing Chao-Yang Hospital between January 2017 and July 2023. Chest CT data were reconstructed using Materialise Mimics. Pulmonary veins and lung lobes were segmented from surrounding tissue based on an appropriate threshold determined by local grey values and image gradients. Subsequently, venous cross-sectional areas and lung volumes were measured for statistical analysis.

Result: CT data from 174 inpatients with bronchiectasis and 75 cases from the health examination center were included. Three-dimensional reconstruction data revealed a significant reduction in cross-sectional areas of pulmonary veins in the left lower lobe (p < 0.001), the right lower lobe (p = 0.030), and the right middle lobe (p = 0.009) of bronchiectasis patients. Subgroup analyses indicated that approximately 73.5% of localized cases of the left lower lobe exhibited pulmonary vein stenosis, while in the diffuse group, this proportion was only 52.6%. Furthermore, the cross-sectional area of pulmonary veins had a gradually decreasing trend, based on a small sample. Lung function tests showed significant reductions in FEV1, FVC, and FEV1% in bronchiectasis patients, attributed to the loss of lung volume in the left lower lobe, which accounted for 60.9% of the included sample.

Conclusions: Our recent findings suggest that pulmonary venous stenosis is a common variation in bronchiectasis and is often observed concurrently with reduced lung volume, particularly affecting the left lower lobe. Moreover, localized cases are more likely to suffer from pulmonary venous stenosis, with an ambiguous downtrend as the disease progresses. In conclusion, increased attention to pulmonary venous variation in bronchiectasis is warranted, and exploring new therapies to intervene in the early stages or alleviate obstruction may be beneficial.

Keywords: 3D reconstruction; bronchiectasis; lung function; lung volume; pulmonary venous stenosis.

Figure 1

Distribution of onset age of medical patients diagnosed with bronchiectasis and age at the time of surgery for bronchiectasis. The age distribution of patients who underwent surgical treatment for bronchiectasis is younger than that of patients who received conservative treatment.

Figure 2

Location of bronchiectasis. The PVS is more common in the left lower lobe, right middle lobe, and right lower lobe, even though in most cases the lesions involve multiple lobes.

Figure 3

3D reconstruction for bronchiectasis of bilateral lower lobes and middle lobe. (A) PVS in left lower lobe, (B) PVS in right middle lobe, (C) PVS in right lower lobe. D1: diameter along major axis, D2: diameter along minor axis, E: eccentricity, DP: distance to periapsis, DA: distance to apoapsis.

Figure 4

Trend of gradual aggravation of pulmonary venous stenosis in a long-term observation. The degree of pulmonary vein stenosis increases very slowly over time, and this change may take more than a decade or even longer.

Figure 5

Pulmonary vein cross-sectional areas (PVCA) and lung lobe volumes of each lung lobe. *** p < 0.001, ** p < 0.01, * p < 0.05. (A) PVCA of each lung lobe. (B) Lung lobe volumes of each lung lobe.

Figure 5

Pulmonary vein cross-sectional areas (PVCA) and lung lobe volumes of each lung lobe. *** p < 0.001, ** p < 0.01, * p < 0.05. (A) PVCA of each lung lobe. (B) Lung lobe volumes of each lung lobe.