Increased Bronchovascular Markings on Chest X-Ray: Causes

Prominent bronchovascular markings indicate thickened or more visible bronchial walls and pulmonary vessels. Common causes:

Inflammatory/Infectious

• Pneumonia (alveolar + interstitial inflammation).
• Bronchitis (acute/viral; chronic in smokers).
• Viral lower respiratory infections (RSV, COVID-19).

Fluid Overload / Hemodynamic

• Congestive heart failure (interstitial edema, Kerley B lines, cephalization).
• Pulmonary edema (cardiogenic or non-cardiogenic/ARDS).
• Fluid overload (renal failure, excessive IVF, cirrhosis).
• Mitral stenosis/regurgitation.

Other

• Pulmonary venous hypertension.
• Lymphangitic carcinomatosis.
• Sarcoidosis (peribronchovascular nodules).
• Normal variant in smokers/elderly (mild prominence).

Fluid Overload Mechanisms

• Excess intake (especially with renal/cardiac impairment).
• Heart failure → ↑hydrostatic pressure → transudation.
• Hypoalbuminemia (nephrotic, liver failure) → ↓oncotic pressure.
• Capillary leak (sepsis, ARDS).

Management

Treat underlying cause: diuretics for volume overload, antibiotics for infection, afterload reduction for HF, dialysis for uremia. Chest X-ray follows clinical response.