Tree in bud

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The “tree-in-bud” pattern at thin-section computed tomography is characterized by small centrilobular nodules of soft-tissue attenuation connected to multiple branching linear structures of similar caliber originating from a single stalk. This pattern also resembles the small objects used in the childhood game of jacks.

• Initially described in cases of endobronchial spread of Mycobacterium tuberculosis.
• The “tree-in-bud” pattern has subsequently been reported as a manifestation of a variety of entities, including:
  • Peripheral airway diseases such as infection (bacterial, fungal, viral, or parasitic)
  • Congenital disorders
  • Idiopathic disorders (obliterative bronchiolitis, panbronchiolitis)
  • Aspiration
  • Inhalation
  • Immunologic disorders
  • Connective tissue disorders
  • Peripheral pulmonary vascular diseases (i.e. neoplastic pulmonary emboli).

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