To evaluate the blood flow patterns of peripulmonary lesions by color Doppler ultrasound and compare the differences of blood flow patterns between benign and malignant lesions.

From June 2020 to July 2021, a total of 87 inpatients with peripulmonary lesions diagnosed by CT imaging examination were enrolled at Xi'an Chest Hospital, and all patients were confirmed by pathological diagnosis. The blood flow patterns of peripulmonary lesions were detected and classified using Colour Doppler ultrasound, which were divided into four types: type A, the presence of both intercostal artery blood supply patterns and dendritic reflux patterns of intrapulmonary veins in peripulmonary lesions; type B, the presence of intercostal artery blood supply pattern of peripulmonary lesions, but the absence of dendritic reflux of intrapulmonary veins; type C, the absence of intercostal artery blood supply pattern of lesions, but the presence of dendritic reflux pattern of intrapulmonary veins; type D, the absence of both intercostal artery blood supply pattern and dendritic reflux pattern of intrapulmonary veins in peripulmonary lesions. The differences of blood flow patterns between benign and malignant lesions were compared, and the value of blood flow patterns in distinguishing benign and malignant lesions was assessed by ROC curve analysis.

The blood flow patterns of 87 peripulmonary lesions were: type A in 19 cases, type B in 6, type C in 42, and type D in 20, of which 65 were benign (74.7%) and 22 were malignant (25.3%). By comparing the blood flow patterns of benign and malignant lesions, it was found that the dendritic reflux of intrapulmonary veins was the benign feature of peripulmonary lesions, and its constituent ratio was higher in the benign group than in the malignant group (90.8% vs 19.1%, χ²=53.332, P＜0.001); the sensitivity, specificity, and area under the curve of this pattern were 90.8%, 97.9%, and 0.908 (95% CI: 0.837-0.979, P＜0.001), respectively. Intraoperative bleeding volume [510.0 (477.5730.0) ml] was significantly increased in patients with intercostal artery supply to the malignant lesion [400.0 (350.0, 450.0) ml] than patients without (Z=2.627, P=0.009).

There are differences in blood flow patterns between benign and malignant peripulmonary lesions. The dendritic reflux pattern of intrapulmonary veins is a benign feature of peripulmonary lesions. The blood supply pattern of intercostal arteries in patients with malignant lesions increases the risk of intraoperative bleeding, which requires close clinical attention.