Tree-in-Bud Pattern of Pulmonary Tuberculosis on Thin-Section CT: Pathological Implications

Korean Journal of Radiology : Official Journal of the Korean Radiological Society
Jung-Gi Im, Harumi Itoh

Abstract

The "tree-in-bud-pattern" of images on thin-section lung CT is defined by centrilobular branching structures that resemble a budding tree. We investigated the pathological basis of the tree-in-bud lesion by reviewing the pathological specimens of bronchograms of normal lungs and contract radiographs of the post-mortem lungs manifesting active pulmonary tuberculosis. The tree portion corresponds to the intralobular inflammatory bronchiole, while the bud portion represents filling of inflammatory substances within alveolar ducts, which are larger than the corresponding bronchioles. Inflammatory bronchiole per se represents the "tree" (stem) and inflammatory alveolar ducts constitute the "buds" or clubbing. "Clusters of micronodules", seen on 7-mm thick post-mortem radiographs with tuberculosis proved to be clusters of tree-in-bud lesions within the three-dimensional space of secondary pulmonary lobule based on radiological/pathological correlation. None of the post-mortem lung specimens showed findings of lung parenchymal lymphatics involvement.

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Citations

Nov 26, 2020·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·Yeon Hyeon Choe
Jun 22, 2021·American Journal of Respiratory and Critical Care Medicine·Véronique Dartois, Thomas Dick
Aug 10, 2021·Radiology Case Reports·Som Subhro BiswasSampreet Kaur Awal
May 21, 2021·American Journal of Respiratory and Critical Care Medicine·Gordon WellsAdrie J C Steyn

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