Thorax 68:399-400 doi:10.1136/thoraxjnl-2012-202064
  • Chest clinic
  • Images in Thorax

“Tree in bud” attributable to organising pneumonia

  1. B van den Blink1
  1. 1Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
  2. 2Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
  3. 3Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr B van den Blink, Pulmonary Medicine, Erasmus MC, 's Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands; b.vandenblink{at}
  • Received 19 April 2012
  • Accepted 5 July 2012
  • Published Online First 27 July 2012

Learning point

  • 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 …