“Tree in bud” attributable to organising pneumonia
- 1Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
- 2Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
- 3Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
- Correspondence to Dr B van den Blink, Pulmonary Medicine, Erasmus MC, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; b.vandenblink{at}erasmusmc.nl
- Received 19 April 2012
- Accepted 5 July 2012
- Published Online First 27 July 2012
Learning point
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Cryptogenic OP may rarely present as a small airway-predominant disease causing severe airflow limitation and a ‘tree in bud’ pattern on HR-CT.
A 19-year-old man presented with dyspnoea, a non-productive cough and subfebrile temperature. Chest radiography showed a diffuse nodular pattern and a pneumomediastinum. HR-CT revealed a diffuse ‘tree in bud’ pattern (figure 1). An infectious bronchiolitis was suspected. Despite treatment with moxifloxacin he developed hypercapnic respiratory failure requiring mechanical ventilation. Extensive microbiological investigations did not reveal a pathogenic microorganism. Continued treatment with antibiotics, low-dose steroids and neomacrolides was not effective, and an open lung biopsy …
