Faces of Tree in Bud

Infection Inflammation Malignancy Mechanical/Atelectasis Trauma Metabolic Circulatory- Hemorrhage Immune Infiltrative Idiopathic Iatrogenic Idiopathic

Infection

Transbronchial Spread of TB with Cavitation

CT –Reactivation TB – Cavitating Infiltrate Left Upper Lobe Connecting with Airways
CT scan in the coronal plane of the left upper lobe of a 28-year-old immigrant with cough shows a thick walled cavitating mass subtended by a subsegmental thick-walled airway. Lab tests confirmed the diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136081c
CT –Reactivation TB – Left Upper Lobe
CT scan in the axial plane of the left upper lobe of a 28-year-old immigrant with cough shows a focal subsegmental consolidation with focal cavitation (yellow arrowhead) subtended by a thick-walled subsegmental airway. There are extensive tree in bud changes ringed in white (b and c) indicating transbronchial spread. Lab tests confirmed a diagnosis of TB and the patient was treated with RISE, a 4-month treatment regimen of rifapentine-moxifloxacin for mycobacterium tuberculosis.
Ashley Davidoff MD TheCommonVein.net 255Lu 136075cL

 

CT Active TB Transbronchial Spread with Extensive Tree in Bud Changes
39-year-old immigrant Vietnamese male presents night sweats fever and cough. CT in the axial plane through the mid chest shows innumerable micronodules resulting from transbronchial spread with resultant tree in bud pattern scattered through the right lung (magnified in the right lower image). There are minimal similar changes in the lingula (magnified left lower image)..
Ashley Davidoff MD TheCommonvein.net 135789c 006Lu

Small Airway Disease and Tree in Bud Changes -Right Upper Lobe Active TB

Small Airway Disease and Tree in Bud Changes -Right Upper Lobe Active TB
CT in the axial plane shows extensive small airway disease dominant in the right upper lobe characterized by innumerable, ground glass micronodules, and tree in bud changes. (a magnified in c and b magnified in d)
Ashley Davidoff MD TheCommonVein.net 135827aL 192Lu

Inflammation
ABPA Early

Mucoid Impaction and Tree in Bud
ABPA Current
CT Scan RUL
72 year old female with asthma with cough and chronic dyspnea.
CT in the axial plane shows thickening of the segmental and subsegmental airways of the posterior segment of the right upper lobe with mucoid impaction and tree in bud formation
Ashley Davidoff MD TheCommonVein.net 294Lu 117967c

ABPA Advanced

CT scan Left Upper Lobe ABPA  – Tree in Bud  
60 year old male with history of asthma, allergic bronchopulmonary aspergillosis (ABPA)
CT scan shows left  upper lobe bronchiectasis  and soft tissue/fluid  impaction in the anterior segmental and subsegmental airways associated with tree in bud appearance (yellow arrowhead) and centrilobular nodules (red arrowhead) reminiscent of associated small airway disease
Ashley Davidoff TheCommonVein.net

ABPA

Bronchopneumonic Form of Aspergillosis
43 year old man with known aspergillus infection. Note the thickening of the walls of the segmental subsegmental and small airways with extensive tree in bud changes and bronchial wall thickening. There are centrilobular nodules indicating the small airway disease
Ashley Davidoff MD TheCommonVein.net
117816c

 

Tree in Bud of a Different Sort – Complex Effusion and Compressive Atelectasis

CT  Tree in Bud of a Different Sort – Complex Effusion and Compressive Atelectasis
54-year-old female presents with a cough, fever and leukocytosis and multicentric lung abscesses. CT in the axial plane with the patient in decubitus position prior to diagnostic aspiration shows compressive atelectasis of the right upper and right lower lobes by a complex para-pneumonic effusion. Air bronchograms are noted. The residual air in the in the the airways of the compressed lungs is reminiscent of the tree in bud – but in this case has different implications
Ashley Davidoff MD TheCommonVein.net 19599 art