What Does Centrilobular Nodules With Tree-in-bud Appearance On CT Scan Indicate?

Posted on Mon, 16 Jun 2014

Question: I was suffering from cough for about 3 wks when i got my checkup done i was diagnosed with Pneumonia and was on medication for the same. however i was having constant stabbing pain in the left side of the chest. I got my CT scan done and one of the report says " There is evidence of centrilobular nodular opacities noted in apical segment of right upper lobe, few of them showing tree in bud pattern--likely ineffective" detailed report attached.
What could possibly be the reason for the clots in the chest ?
I would want to know if these are symptoms of or can lead to Tuberculosis ?
If so I can you to suggest some good hospitals in south XXXXXXX that I can go to.

Answered by Dr. Arnab Maji (4 hours later)

Brief Answer:
Chance of tuberculosis is maximum

Detailed Answer:
Hello
Thanks for your queries.
Centrilobular nodules with tree-in-bud appearance on CT scan is because of infections of which the most common is tuberculosis. Bronchopneumonia may also cause such pattern though. I have seen all your reports but no evidence of tuberculosis. But you need to have sputum test for acid-fast bacilli (AFB) and broncho-alveolar lavage study for AFB smear, gram staining and mycobacterial BACTEC MGIT 460 TB culture to find the etiology. Even if these investigations are found to be negative you can be put on anti-tubercular drugs based on symptoms and radiological finding. In all probability tree-in-bud appearance these features on CT scan are suggestive of tuberculosis until other etiologies are proved. You can go VP Chest institute or LRS medical college for better evaluation of your findings and bronchoscopic procedures.
If you have further queries you can write abck to me.
If you are satisfied with my answer you can write a review for me.
Thank you.
Regards,
Dr Arnab Maji
MBBS, MD
Pulmonologist

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj