Tree-in-bud caused by haemophilus influenzae

Case contributed by Dr Euan Zhang

Presentation

SOB and hypoxia. Rule out pneumonia.

Patient Data

Age: 70 years
Gender: Female

The lungs exhibit diffusely increased opacification with subtle nodular opacities scattered throughout bilaterally, greater on the left.

There are tree-in-bud opacities scattered throughout both lungs. There is no associated bronchiectasis, bronchial wall thickening, consolidation, cavitation, or lymphadenopathy. There is no lower lobe predominance, as the distribution is quite diffuse.

Case Discussion

This patient presented with general malaise, productive cough, and increasing shortness of breath. She was intubated soon after her presentation for hypercapnic respiratory failure and admitted to the ICU. Her sputum culture was positive for Haemophilus influenzae. She received steroid therapy as well as ceftriaxone IV for 1 week, after which she was able to be extubated. She did well after extubation and was discharged home two weeks after her presentation.

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