Presentation
Cough & dyspnea
Patient Data
Age: 20-year-old
Gender: Female
From the case:
Tree-in-bud sign - normal CT virtual bronchoscopy
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3D-VR

Normal caliber of the trachea and bronchi with no evidence of stenosis.
From the case:
Tree-in-bud sign - normal CT virtual bronchoscopy
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Axial + Venous phase

Multiple centrilobular nodules and branching linear opacities of similar caliber originating from a single stalk (the tree-in-bud pattern) in the left lower lobe.
Multiple enlarged mediastinal (prevascular, subcarinal) and left hilar lymph nodes.
Case Discussion
Normal CT virtual bronchoscopy.
The patient's symptoms are secondary to the left lower lobar "tree-in-budd densities"
Causes of tree-in-bud sign:
- infective bronchiolitis
- congenital
- connective tissue disorders
- bronchial
- neoplastic
Tree-in-bud in this case was secondary endobronchial spread of tuberculosis.