![]() Scrutinise patient history, including appropriate exposure history, as this may aid in determining the most likely diagnosis 6,7 thickening of the bronchial wall, narrowing of bronchi, bronchiectasis, consolidation, cavitation, necrotic lymphadenopathyĭetermine the location (with gravitational or lower lobe predominance favoring aspiration) 6,7 Identification of the tree-in-bud sign should urge you to Using maximum intensity projection (MIP) can facilitate detection of particularly the centrilobular nodules 6 The connection to opacified or thickened branching structures extends proximally (representing the dilated and opacified bronchioles or inflamed arterioles) 1-3,6. Typically the centrilobular nodules are 2-4 mm in diameter and peripheral, within 5 mm of the pleural surface. Tree-in-bud sign is not generally visible on plain radiographs 2. It is usually visible on standard CT, however, it is best seen on HRCT chest. carcinomatous endarteritis 3,6,7 or bronchovascular interstitial infiltration 4,5)ĭistant metastatic disease (e.g. Obliterative (constrictive) bronchiolitis Staphylococcus aureus, Haemophilus influenzae, Mycobacterium tuberculosis, Mycobacterium avium (MAIC)Īllergic bronchopulmonary aspergillosis (ABPA) While the tree-in-bud appearance usually represents an endobronchial spread of infection, given the proximity of small pulmonary arteries and small airways (sharing branching morphology in the bronchovascular bundle), a rarer cause of the tree-in-bud sign is infiltration of the small pulmonary arteries/arterioles or axial interstitium 3,6,7.īacterial pneumonia, e.g. intravenous talcosis or microcrystalline cellulose in crushed oral tablets ( excipient lung disease) Granulomatous response to excipient material in intravenous drug users (IVDU) 8,9Į.g. Tumor emboli to centrilobular arteries (or carcinomatous endarteritis) cytomegalovirus pneumonitis, obliterative bronchiolitisīronchiectasis/ bronchiolectasis with mucus pluggingīronchovascular interstitial infiltration pulmonary tuberculosis, aspiration bronchopneumoniaīronchiolitis: thickening of bronchiolar walls and bronchovascular bundleĮ.g. ![]() More specifically, the pattern can be manifest because of the following disease processes, often in combination:īronchioles filled with pus or inflammatory exudateĮ.g. Simply put, the tree-in-bud pattern can be seen with two main sites of disease 3: ![]()
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