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

Rossi, Santiago E.; Franquet, Tomás; Volpacchio, Mariano; Giménez, A.; Aguilar, Gabriel

doi:10.1148/rg.253045115

Cited by 172 publications

(89 citation statements)

References 32 publications

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“…A limitation of this study was that a lung biopsy was not mandatory for the diagnosis of bronchiolitis, provided that both airflow obstruction and characteristic direct signs of bronchiolitis on HRCT were present [6,8,9]. Although a definitive diagnosis of bronchiolitis relies on biopsy, this invasive procedure is currently rarely performed in such a setting.…”

Section: Discussionmentioning

confidence: 99%

Hypereosinophilic obliterative bronchiolitis: a distinct, unrecognised syndrome

et al. 2012

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Biopsy-proven cases of eosinophilic bronchiolitis have only been reported in isolation, and all come from Japan.We present six patients with hypereosinophilic obliterative bronchiolitis (HOB), defined by the following criteria: 1) blood eosinophil cell count .1 G?L -1 and/or bronchoalveolar lavage eosinophil count .25%; 2) persistent airflow obstruction despite high-dose inhaled bronchodilators and corticosteroids; and 3) eosinophilic bronchiolitis at lung biopsy (n51) and/or direct signs of bronchiolitis (centrilobular nodules and branching opacities) on computed tomography (n56). Chronic dyspnoea and cough which was often severe, without the characteristic features of asthma, were the main clinical manifestations. Atopy and asthma were present in the history of three and two patients, respectively. One patient met biological criteria of the lymphoid variant of idiopathic hypereosinophilic syndrome. Mean blood eosinophil cell count was 2.7 G?L -1 and mean eosinophil differential percentage at bronchoalveolar lavage was 63%. Mean initial forced expiratory volume in 1 s/forced vital capacity ratio was 50%, normalising with oral corticosteroid therapy in all patients. HOB manifestations recurred when oral prednisone was decreased to 10-20 mg?day -1, but higher doses controlled the disease. HOB is a characteristic entity deserving to be individualised among the eosinophilic respiratory disorders. Thorough analysis is needed to determine whether unrecognised and/or smouldering HOB may further be a cause of irreversible airflow obstruction in chronic eosinophilic respiratory diseases.

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Section: Discussionmentioning

confidence: 99%

Hypereosinophilic obliterative bronchiolitis: a distinct, unrecognised syndrome

et al. 2012

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“…However, most patients have no evidence of embolic disease by pulmonary angiogram [159]. The tree-in-bud pattern is commonly seen on thin-section CT of the lungs, and it consists of small centrilobular nodules of soft tissue attenuation connected to multiple branching linear structures of small calibre that originate from a single stalk [160]. Originally described in cases of endobronchial spread of Mycobacterium tuberculosis, it is now also recognised as a manifestation of PTUE [161].…”

Section: Diagnosismentioning

confidence: 99%

“…BAL typically reveals lymphocytosis with a predominance of CD8 lymphocytes, and talcum crystals can occasionally be seen [238]. Cellulose granulomatosis has also been described as a cause of the tree-in-bud appearance on high-resolution CT: micronodules distributed at the termination of bronchovascular bundles [160,228]. These micronodules represent intra-arteriolar accumulation of microcrystalline cellulose with adjacent granulomatous reaction.…”

Section: Diagnosismentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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“…and, quite rarely, viral infection can all result in a tree-in-bud pattern ( Figure 13) accompanied by variable consolidation (including cytomegalovirus and respiratory syncytial virus). (55) Infectious bronchiolitis…”

Section: Infectious Pneumoniamentioning

confidence: 99%

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

et al. 2008

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High-resolution computed tomography (HRCT) is the radiological imaging technique best suited to revealing changes in lung structure. Various HRCT findings, taken together, can represent typical patterns. These patterns, in conjunction with the anatomical distribution of findings and with clinical data, can narrow the differential diagnosis of diffuse interstitial lung disease and, in many cases, indicate the correct diagnosis with a high degree of accuracy. The most common HRCT patterns seen in cases of diffuse interstitial lung diseases are the nodular pattern, linear/reticular opacities, cystic lesions, ground-glass opacities and consolidations. This article reviews the correlations between HRCT patterns and pathologic findings, summarizing the most common causes, as well as detailing the methods of investigation employed in order to diagnose the most common types of chronic diffuse lung disease.Keywords: Lung diseases, interstitial/pathology; Tomography, X-Ray computed; Diagnostic techniques, respiratory system. ResumoA tomografia de alta resolução (TCAR) é a técnica de imagem radiológica que reflete mais de perto as alterações da estrutura pulmonar. Os vários achados tomográficos podem ser combinados para formar padrões típicos. Estes, conjuntamente com a distribuição anatômica dos achados, e com os dados clínicos, podem estreitar o diagnóstico das doenças intersticiais pulmonares difusas, e em vários casos sugerir o diagnóstico correto com alto grau de acurácia. Os padrões mais comuns das doenças intersticiais pulmonares difusas na TCAR são o nodular, linear e reticular, lesões císticas, opacidades em vidro fosco e consolidações. Este artigo revisa as correlações entre os padrões tomográficos na TCAR e os achados patológicos e resume as causas mais comuns e os métodos de investigação para se atingir um diagnóstico nas doenças pulmonares crônicas difusas mais comuns.Descritores: Doenças pulmonares intersticiais/patologia; Tomografia computadorizada por raios X; Técnicas de diagnóstico do sistema respiratório.* Study carried out in the

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

Cited by 172 publications

References 32 publications

Hypereosinophilic obliterative bronchiolitis: a distinct, unrecognised syndrome

Hypereosinophilic obliterative bronchiolitis: a distinct, unrecognised syndrome

Nonthrombotic pulmonary embolism

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

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