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Chest clinic
Images in Thorax
“Tree in bud” attributable to organising pneumonia
  1. E M T Bots1,
  2. M A den Bakker2,
  3. M S Wijsenbeek1,
  4. L M van den Toorn1,
  5. 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}erasmusmc.nl

https://doi.org/10.1136/thoraxjnl-2012-202064

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    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 …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval Formal consultation with the Medical Ethical Committee of the Erasmus MC learnt that, under the Dutch act for medical research involving human subjects (Wet Medisch Onderzoek), approval of this case report by the Medical Ethical Committee is not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.