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ECR 2019 / C-3494
Tree-in-bud pattern in lung pathology from multi-detector computed tomography perspective
Congress: ECR 2019
Poster No.: C-3494
Type: Educational Exhibit
Keywords: Lung, Thorax, CT, Diagnostic procedure, Infection, Inflammation, Cancer
Authors: L. Pajic1, M. Nisevic2, A. Petkovic1, N. Menkovic1, M. Ilic1, R. STEVIC1, D. Masulovic1; 1Belgrade/RS, 2Beograd/RS

Findings and procedure details


In this five-year retrospective study we analyzed patient with TIB sign at MDCT chest imaging. 41 patients were included in study, 19 males and 22 females, the average age at the time of examination was 57±17. We analyzed presence and localization of TIB sign, presence of ancillary findings and potential diagnosis. The most common localisation of tree-in-bud sign was upper right lobe (28 patient or 68%) and its  anterior segment (15 patients/36.5%), after that lower right and upper left lobe 16 (39%). Two or more lobes were affected in 20 patients (49%) ( Table 2).



Localization of TIB Number Percentage
Upper right lobe 28 68%
Lower Right lobe 16 39%
Upper left lobe 16 39%
Lower left lobe 14 34%
Middle right lobe 8 20%
Two or more lobes 20 49%


 Table 2. Localiyation of TIB



Tree in bud opacities can be seen in isolation, or with other imaging findings. In our study most commonly ancillary finding was lymphadenopathy in 23 patients (56,10%), after that bronchiectasis in 11 patients (26,83%), consolidation in 10 patients (24,39%), ground glass opacities in 9 patients (21,95%), calcifications in 8 patients (19,51%), tumor of the lung in 5 patients (12,20%) and cavernous lesion in 4 patients (9,76%). In 20 patients (48,78%) there were two or more ancillary signs and 4 patients (9,76%) did not have ancillary signs (Table 3).


Ancillary radiology signs Number Percentage
Lymphadenopathy 23 56,10%
Bronchyectasis 11 26,84%
Consolidation 10 24,39%
Ground glass opacities 9 21,95%
Calcifications 8 19,51%
Tumor of the lung 5 12,20%
Cavernous lesion 4 9,76%
Two or more ancillary signs 20 48,78%
No ancillary signs 4 9,76%


 Table 3  Ancillary radiology signs



Tree-in-bud can be recognized in many diverse entities. In our study it is most commonly seen as a sign of endobronchial spread of Mycobacterium  tuberculosis (31 patients/75.6%), than as a sign of endobronchial spred of tumor of the lung (2 patients/4,9%), in broncihiolitis associated with bronchiectasis (2 patients/4,9%), atiypical mycobacteria infection (1 patient/2,4%), aspergillosis infection (2 patients/4.9%), sarcoidosis (1 patient/2,4%), professional lung disease (1 patient/2,4%) and focal pneumonia (1 patient/2,4%) (Table 4).



Causes of TIB pattern Number Percentage
Endobronchial spread of Mycobacterium tuberculosis 31  75,61%
Endobronchial spread of tumor of the lung 2 4,88%
Aspergilosis infection 2 4,88%
Bronchiolitis associated with bronchiectasis 2 4,88%
Atypical mycobacteria infection 1 2,44%
Focal pneumonia 1 2,44%
Prefessional lung disease 1 2,44%
sarcoidosis 1 2,44%


Table 4.  Causes of TIB pattern



Case reports


Case 1.  Aspergilosis


 A 67-year old female patient was administered in our clinic with mild caugh, hemoptisis, fatigue, shortness of breath and  fever. CT showed consolidation in posterobasal segment of left lower lobe, bronchiectasis surrounded by micronodular lesions (tree-in-bud sign). (Fig.12)



Case 2.   Tumor


 A 63-year-old female patient had a large mass on chest radiography. She was administred in our clinic  with prolonged caught, chest pain, shortness of breath, loss of appetite, weight loss, fatigue and weakness. MDCT showed tumor in posterior segment of right upper lobe, surrounded by micronodular lesions and tree-in-bud sign, due to of endobronchial spread of tumor. (Fig.13)



Case 3.   Tuberculosis  


A 19-year-old female  patient was administer  to our clinic, due to hemoptisis, fatigue, fever, night sweats, chills, loss of appetite and weight loss.  MDCT showed consolidation with necrosis in Nelson’s segment of right lower lobe, that is surrounded by peribrochial cenrilobular nodular  lesions ( tree-in-bud sign) and mediastinal limphadenpathy. ( Fig. 14) 



Case 4.  Silicosis


A 66 year-old female patient came to our clinic with sharp cest pain, cagugh and fever.  MDCT showed  psudo-mass lesions, permeated by calcification and perifocal centrilobular nodes, tree-in-bud sign located in Nelson’s segment of lower lobes . ( Fig. 15)



Case 5.  Sarcoidosis


A 43-year old male patient  came to our clinic with caugh, shortness of breath, chest pain, fever, night sweats and weith loss . MDCT showed small centrilobular nodes, peribronchial distribution, forming tree-in-bud pattern and bilateral lymphadenopathy.  ( FIg. 16)



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