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What Does "peribrochial Cuffing In Para Hillar Region" Mean?

Posted on Mon, 24 Mar 2014

Question: My daughter has elevated esr (40) but CBC is normal. Also KFT and LFT are normal. X-ray PA showed peribrochial cuffing in para hillar region. She has some breathing problem sometime.PFT and 2D echo color doppler is O.K. She is 27 years. She is not taking any medicine. Also Quantiferron TB Gold is negative.

Answered by Dr. Kamalpreet Kaur (1 hour later)

Brief Answer: Do not worry for ESR alone Detailed Answer: Hi, Welcome to Healthcaremagic. Your daughter had been on treatment for some bronchitis problem as she was given antibiotic tab. Gudcef AZ and Seroflo inhaler, which is a combination of bronchodilator and steroid. Although she did not take the inhaler but according to her symptoms and X-ray chest that says fluid or mucus collection(peribrochial cuffing)in brochi she was having inflammation of the bronchi. Now, this explains the reason for raised ESR, which is a non specific test and is raised in any inflammatory condition of the body and is just a screening test. It is not for diagnosing a specific disease. Since CBC is normal and was expected to be after a course of antibiotics and all other parameters including Quantiferon gold and Echo, So don't worry about ESR. It will cause no harm. Any other query, happy to help. Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Kamalpreet Kaur (28 minutes later)

Dear Dr XXXXXXX Happy to receive your advise. As you understand rightly, I am anxious. So I would like to inform you that this was first observed during October, 2013 (esr 32). She actually reside in New Delhi near Mathura road. Twice the X-ray have been done (october 13 and XXXXXXX 20,2014). In first report we worried due to the mention of "firbrosis in the lower basal zone". Second one metion as I said here Doctor. Which other specific test I should do for any suspected lungs infection (bacterial and fungal) or wheter there is any need for other tests? Please advise. She has completed the antibiotic course of 7 days 4-5 days back. Hope yous have seen also the attached reports. Looking for your guidance as I could not discuss this in the family. Should she take seroflow 120 or any other medicine for reduction of esr?

Answered by Dr. Kamalpreet Kaur (27 minutes later)

Brief Answer: Other tests not required right now. Detailed Answer: Hi, Thanks for writing back. The concern for your daughter is really appreciable.Further tests depend on her symptoms, whether she is having any problem or breathing difficulty. There is no limit to investigations as you are conscious about bacterial or fungal infection in lungs. I have reviewed all reports thoroughly and all are normal except for mild anemia. Even eosinophils and absolute count is within normal range. Start giving her Seroflo inhalers as advised by your treating dr. and keep her on a regular follow up with him. This will reduce the inflammation of bronchi and also start some iron tablets for anemia. Sometimes, ESR is raised due to anemia only. By taking Seroflo continuously the frequency of her requirement for antibiotics and oral bronchodilators / steroids, if she needs will also go down slowly. One more advise from my side, always treat a patient and not the reports. Thanks. I hope I have answered your query. Yes, if still other tests these may be CT Chest or Bronchoscopy ,but again not without the advise of a chest specialist.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Kamalpreet Kaur (6 minutes later)

Really thankful for your kind and guiding discussion. Again thank you very much

Answered by Dr. Kamalpreet Kaur (24 hours later)

Brief Answer: You are welcome. Detailed Answer: You are welcome Sir. If you are satisfied with the discussion we can stop the conversation. Regards.

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Above answer was peer-reviewed by : Dr. Prasad