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RSNA Education Exhibits

Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview

Published Online:May 1 2005https://doi.org/10.1148/rg.253045115

Abstract

The tree-in-bud pattern is commonly seen at thin-section computed tomography (CT) of the lungs. It consists of small centrilobular nodules of soft-tissue attenuation connected to multiple branching linear structures of similar caliber that originate from a single stalk. Originally reported in cases of endobronchial spread of Mycobacterium tuberculosis, this pattern is now recognized as a CT manifestation of many diverse entities. These entities include peripheral airway diseases such as infection (bacterial, fungal, viral, or parasitic), congenital disorders, idiopathic disorders (obliterative bronchiolitis, panbronchiolitis), aspiration or inhalation of foreign substances, immunologic disorders, and connective tissue disorders and peripheral pulmonary vascular diseases such as neoplastic pulmonary emboli. Knowledge of the many causes of this pattern can be useful in preventing diagnostic errors. In addition, although the causes of this pattern are frequently indistinguishable at radiologic evaluation, the presence of additional radiologic findings, along with the history and clinical presentation, can often be useful in suggesting the appropriate diagnosis.

© RSNA, 2005

References

  • 1 ImJG, Itoh H, Shim YS, et al. Pulmonary tuberculosis: CT findings—early active disease and sequential change with antituberculous therapy. Radiology1993; 186: 653–660.
    Medline Google Scholar
  • 2 EisenhuberE. The tree-in-bud sign. Radiology2002; 222: 771–772.
    Google Scholar
  • 3 HatipogluON, Osma E, Manisali M, et al. High resolution computed tomographic findings in pulmonary tuberculosis. Thorax1996; 51: 397–402.
    Medline Google Scholar
  • 4 CollinsJ, Blankenbaker D, Stern EJ. CT patterns of bronchiolar disease: what is “tree-in-bud”? AJR Am J Roentgenol1998; 171: 365–370.
    Medline Google Scholar
  • 5 RossiSE, Erasmus JJ, McAdams HP. Thoracic manifestations of tuberculosis. Contemp Radiol, Feb2000; 23(5): 1–6.
    Google Scholar
  • 6 MillerWT. Spectrum of pulmonary nontuberculous mycobacterial infection. Radiology1994; 191: 343–350.
    Medline Google Scholar
  • 7 PrimackSL, Logan PM, Hartman TE, Lee KS, Muller NL. Pulmonary tuberculosis and Mycobacterium avium-intracellulare: a comparison of CT findings. Radiology1995; 194: 413–417.
    Medline Google Scholar
  • 8 ErasmusJJ, McAdams HP, Farrell M, Patz EF Jr. Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. RadioGraphics1999; 19: 1487–1503.
    Google Scholar
  • 9 ReichJM, Johnson RE. Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern: the Lady Windermere syndrome. Chest1992; 101: 1605–1609.
    Medline Google Scholar
  • 10 FranquetT, Muller NL, Gimenez A, Guembe P, de La Torre J, Bague S. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. RadioGraphics2001; 21: 825–837.
    Google Scholar
  • 11 FranquetT, Lee KS, Muller NL. Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. AJR Am J Roentgenol2003; 181: 1059–1063.
    Medline Google Scholar
  • 12 KoJP, Shepard JA, Sproule MW, et al. CT manifestations of respiratory syncytial virus infection in lung transplant recipients. J Comput Assist Tomogr2000; 24: 235–241.
    Medline Google Scholar
  • 13 SantisG, Geddes D. Recent advances in cystic fibrosis. Postgrad Med J1994; 70: 247–251.
    Medline Google Scholar
  • 14 HelbichTH, Heinz-Peer G, Eichler I, et al. Cystic fibrosis: CT assessment of lung involvement in children and adults. Radiology1999; 213: 537–544.
    Google Scholar
  • 15 HelbichTH, Heinz-Peer G, Fleischmann D, et al. Evolution of CT findings in patients with cystic fibrosis. AJR Am J Roentgenol1999; 173: 81–88.
    Medline Google Scholar
  • 16 KingTE. Overview of bronchiolitis. Clin Chest Med1993; 14: 607–610.
    Medline Google Scholar
  • 17 HwangJH, Kim TS, Lee KS, et al. Bronchiolitis in adults: pathology and imaging. J Comput Assist Tomogr1997; 21: 913–919.
    Medline Google Scholar
  • 18 MullerNL, Miller RR. Diseases of the bronchioles: CT and histopathologic findings. Radiology1995; 196: 3–12.
    Google Scholar
  • 19 FitzgeraldJE, King TE Jr, Lynch DA, Tuder RM, Schwarz MI. Diffuse panbronchiolitis in the United States. Am J Respir Crit Care Med1996; 154: 497–503.
    Medline Google Scholar
  • 20 TsangKW. Diffuse panbronchiolitis: diagnosis and treatment. Clin Pulm Med2000; 7: 245–252.
    Google Scholar
  • 21 SugiyamaY. Diffuse panbronchiolitis. Clin Chest Med1993; 14: 765–772.
    Medline Google Scholar
  • 22 KrishnanP, Thachil R, Gillego V. Diffuse pan-bronchiolitis: a treatable sinobronchial disease in need of recognition in the United States. Chest2002; 121: 659–661.
    Medline Google Scholar
  • 23 AkiraM, Kitatani F, Lee YS, et al. Diffuse pan-bronchiolitis: evaluation with high-resolution CT. Radiology1988; 168: 433–438.
    Google Scholar
  • 24 MatsuseT, Oka T, Kida K, Fukuchi Y. Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest1996; 110: 1289–1293.
    Medline Google Scholar
  • 25 FranquetT, Gimenez A, Roson N, Torrubia S, Sabate JM, Perez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. RadioGraphics2000; 20: 673–685.
    Google Scholar
  • 26 MaromEM, McAdams HP, Sporn TA, Goodman PC. Lentil aspiration pneumonia: radiographic and CT findings. J Comput Assist Tomogr1998; 22: 598–600.
    Medline Google Scholar
  • 27 McAdamsHP, Rosado-de-Christenson ML, Templeton PA, Lesar M, Moran CA. Thoracic mycoses from opportunistic fungi: radiologic-pathologic correlation. RadioGraphics1995; 15: 271–286.
    Google Scholar
  • 28 GotwayMB, Dawn SK, Caoili EM, Reddy GP, Araoz PA, Webb WR. The radiologic spectrum of pulmonary Aspergillus infections. J Comput Assist Tomogr2002; 26: 159–173.
    Medline Google Scholar
  • 29 PerezT, Remy Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Respir Crit Care Med1998; 157: 1658–1665.
    Medline Google Scholar
  • 30 RossiSE, Goodman PC, Franquet T. Nonthrombotic pulmonary emboli: review. AJR Am J Roentgenol2000; 174: 1499–1508.
    Medline Google Scholar
  • 31 FranquetT, Gimenez A, Prats R, Rodriguez-Arias JM, Rodriguez C. Thrombotic microangiopathy of pulmonary tumors: a vascular cause of tree-in-bud pattern on CT. AJR Am J Roentgenol2002; 179: 897–899.
    Medline Google Scholar
  • 32 TackD, Nollevaux MC, Gevenois PA. Tree-in-bud pattern in neoplastic pulmonary emboli. AJR Am J Roentgenol2001; 176: 1421–1422.
    Medline Google Scholar

Article History

Published in print: May 2005