Presentation
Fever and productive cough for 1 month. History of weight loss.
Patient Data
Multiple centrilobular nodular opacities in the bilateral lung fields with the opacified distal bronchioles give a "tree in bud" appearance along with fluffy consolidation predominantly in bilateral upper lobes.
Left-sided pleural effusion.
Few prominent mediastinal lymph nodes; largest measuring about 11 mm in its short axis in the pre-carinal region.
Case Discussion
The “tree-in-bud” pattern in HRCT is characterized by tiny, hypodense centrilobular nodules connected to multiple branching linear structures arising from a single bronchiole. Active pulmonary tuberculosis with endobronchial spread is one of the most common causes of this radiological pattern. The right upper lobe and right main bronchus are the common locations for the involvement; however, here, in our case, diffuse involvement can be appreciated in bilateral lung fields.
Sputum for acid-fast bacilli (AFB) was performed, which revealed Mycobacterium tuberculosis bacteria as the causative agent for these lesions.
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