Tuberculosis (endobronchial dissemination) - Thoracic Imaging
Title: Thoracic Imaging - Tuberculosis (endobronchial dissemination)
Diagnosis: Tuberculosis (endobronchial dissemination)
Author: Martins Martina
Comment: Howarth Nigel
Department: Département de Radiologie
KeyWords: TBC; pulmonary infection
Chapter: Infectious pneumopathy
Clinical Presentation: Patient with fatigue, weight loss, cough andhemoptysis.
Comment: Endobronchial dissemination can occur when lesions areexcavated.
The presence of small, centrilobular lesions, eithernodular or branching, produces the
typical tree-in-bud sign. Thispattern is due to a dilatation of bronchiolar lumen, filled
withcaseum, combined with an inflammation of the peribronchiolaralveoli. These findings
are generally associated with earlyinfection.
Description: The frontal chest X-ray shows multiple confluentnodular opacities in
the left upper lobe. CT images show numerousill-defined centrilobular nodules, of various
sizes, and branchinglinear opacities, resembling a budding tree ("tree-in-bud" sign).There
are two small cavities with thick walls in the apicalposterior segment of the left upper lobe.
References: Aquino SL, Gamsu G, Webb WR, Kee STl. Tree-in-budpattern:
frequency and significance on thin section CT. J ComputAssist Tomogr 1996; 20:594-599.
Eisenburgh E. The Tree-in-Bud Sign.Radiology 2002; 222:771-772. Leung AN. Pulmonary
tuberculosis: theessentials. Radiology 1999; 210:307-322.
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