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DOI: 10.1148/rg.253045115
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RadioGraphics 2005;25:789-801
© RSNA, 2005

EDUCATION EXHIBIT

Tree-in-Bud Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview1

Santiago Enrique Rossi, MD, Tomas Franquet, MD, Mariano Volpacchio, MD, Ana Giménez, MD and Gabriel Aguilar, MD

1 From the Department of Radiology, Centro de Diagnostico Dr Enrique Rossi, Arenales 2777, CP 1425, Buenos Aires, Argentina (S.E.R., M.V., G.A.); and the Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain (T.F., A.G.). Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Scientific Assembly. Received May 26, 2004; revision requested August 26 and received November 29; accepted December 6. All authors have no financial relationships to disclose. Address correspondence to S.E.R. (e-mail: santirossi{at}cdrossi.com).

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






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