Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
3,032
On Slideshare
3,019
From Embeds
13
Number of Embeds
3

Actions

Shares
Downloads
24
Comments
0
Likes
0

Embeds 13

http://smcphysiciansmeet.blogspot.in 7
http://smcphysiciansmeet.blogspot.com 5
http://www.smcphysiciansmeet.blogspot.com 1

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • Figure 1. Photograph of a twig obtained from a budding tree in spring.
  • Figure 1.  High-resolution CT scan (far left) and drawings of the lung (middle left), a budding tree (middle right), and tree buds (far right) show the tree-in-bud pattern. Note the similarity of the obstructed bronchioles to the objects used in the game of jacks.
  • Figure 2.  Postprimary active tuberculosis in a 66-year-old woman with a chronic cough. High-resolution CT scans of the right lung show peripheral, poorly defined, small (2–4-mm-diameter) centrilobular nodules and branching linear opacities of similar caliber originating from a single stalk (the tree-in-bud pattern) in the lower lobe (arrow). These findings represent endobronchial spread of tuberculosis.

Transcript

  • 1. PROF.DR.G.SUNDARAMURTHY’S UNIT M7 DR.BHARGAVI.K IMAGE OF THE WEEK
  • 2. HISTORY IN BRIEF
    • 48 yr old male was admitted
    • With c/o hemoptysis for 1 day-10 episodes
    • c/o giddiness
    • k/c/o HT on Rx
    • not a k/c/o PT
    • On examination:Gen exmn- was normal
    • Cvs-NAD
    • Rs-fine crepts + right interscapular and subscapular areas.
  • 3.
    • INVESTIGATIONS
    • Rbs,Rft- within normal limits
    • Hb-9.2 gms, complete profile- normal
    • Sputum AFB- negative
    • Further imaging ensued…….
  • 4.  
  • 5.  
  • 6.  
  • 7.  
  • 8.
    • Lung parenchyma shows TREE IN BUD OPACITY S/O ENDOBRONCHIAL SPREAD OF INFECTION, noted in R UPPER LOBE INVOLVING AZYGOUS LOBE ,LIMITED BY AZYGOUS fissure, apical anterior segment.
    • Tiny nodular opacities noted in throughout lung tissues on both sides.
    • ?TB etiology.
  • 9. .
  • 10. Figure 1.  High-resolution CT scan (far left) and drawings of the lung (middle left), a budding tree (middle right), and tree buds (far right) show the tree-in-bud pattern.
  • 11. Rossi S E et al. Radiographics 2005;25:789-801 ©2005 by Radiological Society of North America
  • 12.
    • THE TERMINAL TUFTS - inflammation with caseous material in the respiratory bronchioles and alveolar ducts
    • STALKS - caseous material within the terminal bronchiole
  • 13.
    • Secondary PULMONARY lobule is supplied by a lobular bronchiole and a lobular artery that are located in the center of the lobule.
  • 14.
    • Under normal circumstances, the intralobular bronchiole is less than 1 mm in diameter and is not normally visible on CT scans
    • However, diseased bronchioles with mucous plugging with pus,fluid, wall thickening, or dilatation and peribronchiolar inflammation can be visualized on thin-section CT scans, often displaying the tree-in-bud phenomenon
  • 15. Abnormal – tree in bud
    • Normal ct section
  • 16. TREE IN BUD PATTERN
    • Infection
    • Bacterial
      • Tuberculosis(72%)
      • Non-tuberculosis-MAC,staph aureus,H.influenzae.
    • Fungal
      • Aspergillus
    • Viral
      • Cytomegalovirus
      • Respiratory syncytial virus
    • Idiopathic disorders
      • Obliterative bronchiolitis
      • Diffuse panbronchiolitis
  • 17.
    • CONGENITAL DISORDERS
          • Cystic fibrosis
          • Kartagener’s syndrome
    • IMMUNOLOGICAL DISORDERS
      • Allergic bronchopulmonary aspergillosis
    • CONNECTIVE TISSUE DISORDER
      • Rheumatoid arthritis
      • Sjogren’s syndrome
    • MISCELLANEOUS
      • Aspiration
      • Inhalation of toxic fumes of gases
      • Langerhans cell histocytosis
      • Sarcoidosis
    • TUMOURS
    • PERIPHERAL PULMONARY VASCULAR DISEASE
    • Thrombotic micro-angiography
  • 18. ENDOBRONCHIAL TB - TUBERCULOUS INFECTION OF THE TRACHEOBRONCHIAL TREE WITH MICROBIAL AND HISTOPATHOLOGICAL EVIDENCE -10-40% OF PATIENTS WITH ACTIVE PULMONARY TUBERCULOSIS.
  • 19. ENDOBRONCHIAL TB PATHOGENESIS
    • direct implantation of tubercle bacilli
    • into the bronchus from an adjacent pulmonary parenchymal lesion
    • direct airway infiltration from an
    • adjacent tuberculous mediastinal lymph node
    • Erosion and protrusion of an intrathoracic tuberculous lymphnode into the bronchus
    • hematogenous spread
    • extension to the peribronchial region by lymphatic
    • drainage.
  • 20. CLASSIFICATION OF ENDOBRONCHIAL TB (chung n lee)
    • ACTIVELY CASEATING(43%)
    • EDEMATOUS-HYPEREMIC,
    • FIBROSTENOTIC
    • TUMOROUS
    • GRANULAR
    • ULCERATIVE
    • NONSPECIFIC
  • 21. CLINICAL SYMPTOMS
    • COUGH
    • DYSPNEA
    • LOCAL WHEEZE
    • HEMOPTYSIS
    • HOARSENESS
    • ANOREXIA
  • 22. SEQUELAE….
    • BRONCHOSTENOSIS
    • BRONCHOSTRICTURES
    • bronchiolitis obliterans
    • bronchocentric granulomatosis
    • BRONCHIECTASIS
  • 23. DIAGNOSIS
    • SPUTUM EXAMINATION is the essential and first step .
    • C X-RAY : NORMAL IN 10-20%
    • BRONCHOSCOPY(BRONCHIAL BIOPSY/BRUSHING/ WASHINGS) AND CT
    • are the methods of choice for accurate diagnosis of Bronchial involvement .
    • Typical bronchoscopic finding is the presence of white gelatinous granulation tissue. The mucosa is nodular, red, vascular and some times ulcerated. It may simulate a bronchogenic Carcinoma
    • Nucleic acid amplification tests , such as PCR
    • and other methods for amplifying DNA
  • 24. TREATMENT
    • ATT- conventional chemotherapy containing INH, rifampicin, pyrazinamide and ethambutol.
    • CORTICOSTERIODS
    • balloon dilatation, self expanding metallic stent(FOR BRONCHIAL STENOSIS)
    • laser, curettage, resection and anastomosis
  • 25. THANK YOU