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.
Imaging: Endobronchial TB
PROF.DR.G.SUNDARAMURTHY’S UNIT M7
HISTORY IN BRIEF
48 yr old male was admitted
With c/o hemoptysis for 1 day-10 episodes
k/c/o HT on Rx
not a k/c/o PT
On examination:Gen exmn- was normal
Rs-fine crepts + right interscapular and
Rbs,Rft- within normal limits
Hb-9.2 gms, complete profile- normal
Sputum AFB- negative
Further imaging ensued…….
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.
material in the
Secondary PULMONARY lobule is
supplied by a lobular bronchiole and a lobular
artery that are located in the center of the
Under normal circumstances, the
intralobular bronchiole is less than 1 mm in
diameter and is not normally visible on
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-
OF THE TRACHEOBRONCHIAL
TREE WITH MICROBIAL AND
-10-40% OF PATIENTS WITH
direct implantation of tubercle bacilli
into the bronchus from an adjacent pulmonary
direct airway infiltration from an
adjacent tuberculous mediastinal lymph node
Erosion and protrusion of an intrathoracic tuberculous
lymphnode into the bronchus
extension to the peribronchial region by lymphatic
SPUTUM EXAMINATION is the essential and first step .
C X-RAY: NORMAL IN 10-20%
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