Tree-in-bud appearance

Case contributed by Jeremy Jones
Diagnosis certain

Presentation

Emphysema and shortness of breath. Exclude PE.

Patient Data

Age: 80 years
Gender: Female
ct

Lingular collapse and widespread plugging of the teminal bronchi. Small peripheral right-sided pulmonary embolus.

Case Discussion

The CTPA demonstrates a small peripheral right-sided pulmonary embolus, but more significant is the widespread terminal bronchial plugging and bronchial wall thickening.  Lingular atelectasis may be a chronic finding.

Certainly, the cause of her symptoms is more likely to be the terminal bronchial plugging (with tree in bud appearance) rather than the tiny PE. 

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