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
|Upper right lobe
|Lower Right lobe
|Upper left lobe
|Lower left lobe
|Middle right lobe
|Two or more lobes
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
|Ground glass opacities
|Tumor of the lung
|Two or more ancillary signs
|No ancillary signs
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
|Endobronchial spread of Mycobacterium tuberculosis
|Endobronchial spread of tumor of the lung
|Bronchiolitis associated with bronchiectasis
|Atypical mycobacteria infection
|Prefessional lung disease
Table 4. Causes of TIB pattern
Case 1. Aspergilosis
A 67-year old female patient was administered in our clinic with mild caugh,
shortness of breath and fever.
CT showed consolidation in posterobasal segment of left lower lobe,
bronchiectasis surrounded by micronodular lesions (tree-in-bud sign).
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,
shortness of breath,
loss of appetite,
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.
Case 3. Tuberculosis
A 19-year-old female patient was administer to our clinic,
due to hemoptisis,
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.
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 .
Case 5. Sarcoidosis
A 43-year old male patient came to our clinic with caugh,
shortness of breath,
night sweats and weith loss .
MDCT showed small centrilobular nodes,
forming tree-in-bud pattern and bilateral lymphadenopathy. ( FIg.