Enfeksiyöz bronşiolit ve tree-in-bud

Özet

Enfeksiyöz bronşiolit, küçük hava yollarının enfeksiyonla ilişkili inflamasyonudur; çocuklarda genellikle viral, erişkinlerde viral veya bakteriyel etkenlerle görülebilir. İnce kesit HRCT’de sentrilobüler nodüller ve bronşiol düzeyindeki dallanan tree-in-bud opasiteleri görülebilir. Patern enfeksiyonu destekler nitelikte olabilir ancak özgül değildir; aspirasyon, enfeksiyon dışı bronşiolitler ve periferik pulmoner vasküler hastalıklar, tümör embolileri dâhil, benzer tree-in-bud görünümüne yol açabilir. Tutulumun yaygınlığını kaydetmek etkilenen akciğer hacmini tanımlamaya, eşlik eden buzlu cam veya konsolidasyonu belirtmek ise bronşiolitik ve pnömonik BT paternlerini tarif etmeye yardımcı olabilir.

Faz ve pencere

HRCT tanısal

Kontrastsız ince kesit inspiryum görüntülerinde sentrilobüler, dallanan yumuşak doku atenüasyonlu opasiteler; dalların uçlarındaki küçük tomurcuk nodüller, bronşiol duvar kalınlaşması ve varsa lobüler buzlu cam veya konsolidasyon aranır. Ekspirasyon serisi varsa eşlik eden lobüler hava hapsi belirginleşebilir.

BT bulguları

• Tree-in-bud — ince dallanan lineer opasitelerle bağlantılı mikronodüller tomurcuklanan ağaç görünümü oluşturur.
• Sentrilobüler nodül — sekonder lobül merkezinde, plevra ve interlobüler septadan uzakta küçük opasite görülür.
• Tree-in-bud paternine eşlik eden bronş duvar kalınlaşması bronş inflamasyonunu destekleyebilir; bronşiol lümeni mukus, püy, kan veya başka materyalle dolabilir.
• Lobüler buzlu cam — lobüler dağılımlı atenüasyon artışı bronş ve damar yapılarını tamamen silmez; enfeksiyonda eşlik eden alveoler tutulum şeklinde görülebilir.
• Segmental konsolidasyon — enfeksiyon distal hava boşluklarına yayıldığında hava bronkogramlı yoğunlaşma eklenebilir.
• Ekspirasyon görüntülerinde belirgin mozaik atenüasyon hava hapsiyle uyumludur ve bronşiol obliterans veya konstriktif bronşiolitte görülebilir.
• Dağılım — bronşiol merkezli çok odaklı tutulum, tek kitle odaklı ya da rastgele dağılmış hematojen nodüler dağılımdan farklıdır.

Normalde

Normal sekonder pulmoner lobülün merkezinde küçük bir pulmoner arteriyol ve bronşiol bulunur; normal bronşioller güncel BT tekniklerinde çoğunlukla seçilmez, lobül çevresindeki interlobüler septalar ince kalır. Aynı düzeyde karşı lobülle kıyaslayarak merkezden dışa dallanan opasiteleri ve normalde görünmeyen bronşiol çizgilerini arayın; sentrilobüler bulgular plevra ve septalara ulaşmadan sonlanır.

Ayırıcı tanı

Endobronşiyal tüberküloz

bronkojen yayılımda tree-in-bud paterni görülebilir; görüntü klinik ve mikrobiyolojik bağlamla birlikte değerlendirilir.

Aspirasyon bronşioliti

BT’de sentrilobüler nodüller ve tree-in-bud opasiteleri görülebilir.

Respiratuvar bronşiolit genellikle sigara kullanımıyla ilişkilidir; BT’de buzlu cam atenüasyonlu sentrilobüler nodüller görülebilir.

Hipersensitivite pnömonisi

nonfibrotik formda yaygın, silik sentrilobüler nodüller veya diffüz ill-definite nodüller görülebilir; bu bulgular klinik maruziyet bağlamında yorumlanır.

Periferik tümör embolisi

nadiren pulmoner arteriyol boyunca dallanan opasiteler görülebilir; vasküler süreklilik ve malignite bağlamı ayırıcı değerlendirmeye yardım eder.

Tuzaklar

• Tree-in-bud görünümünü doğrudan belirli bir mikroba bağlamayın; farklı enfeksiyonlar, aspirasyon ve tümöral yayılım benzer bronşiol dolumuna yol açabilir.
• Pulmoner arteriyoller de sekonder lobül merkezinde seyreder; şüpheli dallanmayı komşu ince kesitlerde izleyerek damar devamlılığını ve bronşiol paternini ayırın.
• Tek kesitteki kısa dallanma, bronşiol dolumunu tek başına kanıtlamaz; komşu ince kesitlerde periferik hava yolu boyunca sürüp sürmediğini ve vasküler devamlılığı kontrol edin.
• Tree-in-bud paterni en sık bronşioler enfeksiyonlarda görülür; aspirasyon ve başka nedenlerle de oluşabildiğinden özgül değildir ve klinik öykü, laboratuvar bulguları ile eşlik eden BT bulguları birlikte değerlendirilmelidir.

Kendini dene

1. Öksürüğü olan hastanın HRCT'sinde bronşiol merkezli dallanan opasiteler ve bunlarla bağlantılı küçük nodüller görülüyor. Bu paternin adı nedir?

   • Tree-in-bud
   • Perilenfatik nodülarite
   • Crazy paving
   • Bal peteği
   Cevabı göster

   Tree-in-bud. Dallanan yapılarla bağlantılı küçük sentrilobüler nodüller tree-in-bud paternini oluşturur.

2. Tree-in-bud görünümü olan hastada BT ile hangi sonucu kesinleştirmek mümkün değildir?

   • Etken mikroorganizma
   • Bronşiol dağılımı
   • Konsolidasyon varlığı
   • Lobar tutulum
   Cevabı göster

   Etken mikroorganizma. Tree-in-bud bir görüntüleme paternidir ve çoğunlukla enfeksiyonla ilişkili olsa da BT tek başına etken mikroorganizmayı belirlemez; etkenin tanımlanması klinik ve mikrobiyolojik değerlendirme gerektirir. Dağılım, konsolidasyon ve tutulan loblar BT görüntülerinde değerlendirilebilir.

İlgili konular

• Mukus tıkacı
• Obliteratif bronşiolit
• Respiratuvar bronşiolit
• Foliküler bronşiolit

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Tree-in-bud patternpmc.ncbi.nlm.nih.gov
2. Recent advances in the understanding of bronchiolitis in adultspmc.ncbi.nlm.nih.gov
3. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guidelinepmc.ncbi.nlm.nih.gov
4. Fibrosing Bronchiolitis Evolving from Infectious or Inhalational Acute Bronchiolitis. A Reversible Lesion.pubmed.ncbi.nlm.nih.gov
5. Bronchiolar disorders: a clinical-radiological diagnostic algorithm.pubmed.ncbi.nlm.nih.gov
6. Comparison of Chest CT Findings of COVID-19, Influenza, and Organizing Pneumonia: A Multireader Study.pubmed.ncbi.nlm.nih.gov
7. The "Tree-in-Bud" Pattern on Chest CT: Radiologic and Microbiologic Correlation.pubmed.ncbi.nlm.nih.gov
8. AUTOMATIC QUANTIFICATION OF TREE-IN-BUD PATTERNS FROM CT SCANS.pubmed.ncbi.nlm.nih.gov
9. Chest CT features of community-acquired respiratory viral infections in adult inpatients with lower respiratory tract infections.pubmed.ncbi.nlm.nih.gov
10. [Acute respiratory failure due to Mycoplasma pneumonia].pubmed.ncbi.nlm.nih.gov
11. Learning shape and texture characteristics of CT tree-in-bud opacities for CAD systems.pubmed.ncbi.nlm.nih.gov
12. Aspiration-Related Alveolar Disease: From Acute Injury to Chronic Pulmonary Sequelae.pubmed.ncbi.nlm.nih.gov
13. Noninfectious Generalized Bronchiolitis in the Setting of Allogeneic Stem Cell Transplantation: A Potential Mimic of Lower Respiratory Tract Infection.pubmed.ncbi.nlm.nih.gov
14. Automatic detection and quantification of tree-in-bud (TIB) opacities from CT scans.pubmed.ncbi.nlm.nih.gov
15. Automatic detection of tree-in-bud patterns for computer assisted diagnosis of respiratory tract infections.pubmed.ncbi.nlm.nih.gov
16. Interstitial Lung Diseases Presenting as Small Nodules: Imaging Phenotypes.pubmed.ncbi.nlm.nih.gov
17. Tuberculosis versus immune-related bronchiolitis under immune checkpoint inhibitor - a diagnostic challenge.pubmed.ncbi.nlm.nih.gov
18. Radiologic patterns of interstitial lung disease: a pictorial review based on the 2025 European Respiratory Society/American Thoracic Society Classification.pubmed.ncbi.nlm.nih.gov
19. Host, Pathogen, and Pulmonary Anatomy in Pneumonia: An Integrated Imaging and Clinical Perspective.pubmed.ncbi.nlm.nih.gov
20. Bacterial Granulomatous Lung Diseases: Radiological Findings and Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
21. Clinical characteristics of community acquired pneumonia due to <i>Mycoplasma pneumoniae:</i> experience from an outbreak.pubmed.ncbi.nlm.nih.gov
22. Lipoid Pneumonia: HRCT and MRI Spectrum, Diagnostic Pitfalls, and Imaging-Based Diagnostic Workflow.pubmed.ncbi.nlm.nih.gov
23. "Tree-in-bud" opacities with false-positive Gaffky score and diffuse aspiration bronchiolitis.pubmed.ncbi.nlm.nih.gov
24. Diffuse panbronchiolitis as parathymic syndrome in a Caucasian man previously treated for thymoma.pubmed.ncbi.nlm.nih.gov
25. Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal.pubmed.ncbi.nlm.nih.gov
26. Tree-in-bud pattern at thin-section CT of the lungs: radiologic-pathologic overview.pubmed.ncbi.nlm.nih.gov
27. Radiologic Deception: A Case Report of Tuberculosis with Nodular Onset and Cystic Conclusion.pubmed.ncbi.nlm.nih.gov
28. Miliary meningeal tuberculosis - an unusual imaging presentation for an early definitive diagnosis.pubmed.ncbi.nlm.nih.gov
29. Diagnostic, prognostic, and therapeutic challenges in patients with hypersensitivity pneumonitis.pubmed.ncbi.nlm.nih.gov
30. Hot Tub Lung: Misdiagnosed Hypersensitivity Pneumonitis Revealing a Mycobacterial Aetiology-A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
31. Acute respiratory failure as a rare presentation of non-fibrotic hypersensitivity pneumonitis: Case series.pubmed.ncbi.nlm.nih.gov
32. CT Findings of Asthma and Asthma-Mimicking Conditions.pubmed.ncbi.nlm.nih.gov
33. Evaluation of Cavitary Lung Lesions with ¹⁸F-FDG PET/CT: Differentiating Benign from Malignant Lesions.pubmed.ncbi.nlm.nih.gov
34. Pulmonary actinomycosis and pulmonary nocardiosis mimicking lung cancer: A case series and narrative review.pubmed.ncbi.nlm.nih.gov
35. Identification of imaging-based pulmonary and extrapulmonary treatable traits in COPD: a review.pubmed.ncbi.nlm.nih.gov
36. The role of radiological imaging in the management of severe and difficult-to-treat asthma.pubmed.ncbi.nlm.nih.gov
37. Disseminated Nocardia species infection manifested with multiple brain abscesses and lung involvement in an immunocompetent patient: a case report.pubmed.ncbi.nlm.nih.gov
38. AWMF S2k Guideline: Diagnosis and Assessment of Lung Disease Caused by Occupational Silica Dust Exposure (Silicosis) - Disease No. 4101 as per Occupational Diseases Ordinance (BKV) Annex 1.pubmed.ncbi.nlm.nih.gov
39. Precision treatment of COPD based on novel imaging phenotypes: a treatable traits approach.pubmed.ncbi.nlm.nih.gov
40. Drug-Induced Interstitial Lung Disease in Lung Cancer Patients.pubmed.ncbi.nlm.nih.gov
41. Nonasthmatic Eosinophilic Bronchitis: An Overlooked Cause of Chronic Cough in Children.pubmed.ncbi.nlm.nih.gov
42. Mapping acute lung allograft dysfunction of unknown cause after lung transplantation: Insights from clinical and radiological patterns.pubmed.ncbi.nlm.nih.gov
43. Perspectives in veterinary medicine: Description and classification of bronchiolar disorders in cats.pubmed.ncbi.nlm.nih.gov
44. Pathologic and Radiologic Correlation of Adult Cystic Lung Disease: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
45. Multiple cystic lung disease.pubmed.ncbi.nlm.nih.gov
46. A 29-Year Old Man With an Enlarging Lung Lesion With Calcifications Giving Finger-in-Glove Appearance.pubmed.ncbi.nlm.nih.gov
47. Lung imaging methods: indications, strengths and limitations.pubmed.ncbi.nlm.nih.gov
48. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach.pubmed.ncbi.nlm.nih.gov
49. Chest Imaging of Patients with Sarcoidosis and SARS-CoV-2 Infection. Current Evidence and Clinical Perspectives.pubmed.ncbi.nlm.nih.gov
50. Precision diagnostics in bronchiectasis: current advances in imaging, microbiology, biomarkers, and digital health.pubmed.ncbi.nlm.nih.gov
51. Bidirectional pathogenesis between non-tuberculous mycobacteria and bronchiectasis: clinical insights, diagnostic challenges and future directions-Perspectives from South Asia.pubmed.ncbi.nlm.nih.gov
52. Fungal Infections in Pediatric Patients With Hematologic Malignancies and Stem Cell Transplantation: Impact on the Upper and Lower Respiratory Systems.pubmed.ncbi.nlm.nih.gov
53. Microbial spectrum, co-detection patterns, and clinical correlations in 10,153 hospitalized children with acute respiratory infections: a large-scale tNGS analysis.pubmed.ncbi.nlm.nih.gov
54. Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review.pubmed.ncbi.nlm.nih.gov
55. An overview of case reports and case series of pulmonary actinomycosis mimicking lung cancer: a scoping review.pubmed.ncbi.nlm.nih.gov
56. Management of pneumonia by the emergency radiologist.pubmed.ncbi.nlm.nih.gov
57. Clinical differentiation between pediatric pulmonary tuberculosis and <i>Mycoplasma pneumoniae</i> pneumonia (Review).pubmed.ncbi.nlm.nih.gov
58. Invasive pulmonary aspergillosis as a sentinel manifestation of good syndrome in a patient with thymoma.pubmed.ncbi.nlm.nih.gov
59. Delayed Diagnosis of Common Variable Immunodeficiency Revealed by Recurrent Respiratory Infections and Persistent Mediastinal Lymphadenopathy: A Case Report.pubmed.ncbi.nlm.nih.gov
60. Vitamin D receptor polymorphisms as predictors of pediatric infectious disease prevalence and outcome: an overview of available evidence.pubmed.ncbi.nlm.nih.gov
61. Acute Respiratory Infections Hospitalizations and In-Hospital Mortality in Ecuador: Differences in Patterns Between Pediatric and Adult Populations.pubmed.ncbi.nlm.nih.gov
62. Complete Blood Count-Derived Inflammatory Markers in Pediatric Lower Respiratory Tract Infection: A Narrative Review.pubmed.ncbi.nlm.nih.gov
63. Mycobacterium avium complex pulmonary disease in rheumatoid arthritis-associated interstitial lung disease under non-biologic immunomodulatory therapy: A case report.pubmed.ncbi.nlm.nih.gov
64. Pulmonary Pseudosequestration in a Child with Down Syndrome.pubmed.ncbi.nlm.nih.gov
65. High-Resolution CT Findings in Interstitial Lung Disease Associated with Connective Tissue Diseases: Differentiating Patterns for Clinical Practice-A Systematic Review with Meta-Analysis.pubmed.ncbi.nlm.nih.gov
66. Lung ultrasound and the interstitial syndrome in tuberculosis endemic regions: illustrated insights from diverse clinical settings.pubmed.ncbi.nlm.nih.gov
67. Narrative Review of the Pathophysiology of Post-Infectious Bronchiolitis Obliterans.pubmed.ncbi.nlm.nih.gov
68. Diagnosis and Management of Small Airways Disease.pubmed.ncbi.nlm.nih.gov
69. An Ex Vivo Model of Post Infectious Bronchiolitis Obliterans in Children Using Reconstituted Human Bronchial Epithelium.pubmed.ncbi.nlm.nih.gov
70. Taiwan consensus on pulmonary chronic graft-versus-host disease: A joint statement from the Taiwan Society of Blood and Marrow Transplantation (TBMT) and Taiwan Society of Pulmonary and Critical Care Medicine (TSPCCM).pubmed.ncbi.nlm.nih.gov
71. Clinical Characteristics of 31 Patients with Chest Pain Variant Asthma.pubmed.ncbi.nlm.nih.gov
72. Childhood Interstitial Lung Disease (chILD) Associated With Toxic Chemical Inhalation Exposures: A State-of-the-Art Review.pubmed.ncbi.nlm.nih.gov
73. Fleischner Society: Glossary of Terms for Thoracic Imaging.pubmed.ncbi.nlm.nih.gov
74. Radiographic Distribution as a Diagnostic Clue in Pulmonary Disease.pubmed.ncbi.nlm.nih.gov
75. Frequency of Radiologic Bronchiolocentric Interstitial Pneumonia Patterns and Associated Factors in Welders.pubmed.ncbi.nlm.nih.gov
76. Pediatric diamond-blackfan anemia after hematopoietic stem cell transplantation complicated by bronchiolitis obliterans and air-leak syndrome leading to lung transplantation: a case report with multimodal follow-up.pubmed.ncbi.nlm.nih.gov
77. Therapeutic interventions and pulmonary function in pediatric patients with post-infectious bronchiolitis obliterans.pubmed.ncbi.nlm.nih.gov
78. Imaging Markers of Chronic Obstructive Pulmonary Disease on Computed Tomography of the Lungs: a Narrative Review.pubmed.ncbi.nlm.nih.gov
79. Abnormalities on chest high-resolution computed tomography in patients with cough-variant asthma.pubmed.ncbi.nlm.nih.gov
80. Clinical features and chest CT findings of <i>Chlamydia pneumoniae</i> pneumonia.pubmed.ncbi.nlm.nih.gov
81. Deep learning‑based ultra-high-resolution CT imaging of viral pneumonia at admission and after discharge.pubmed.ncbi.nlm.nih.gov
82. Efficacy of High-Dose Versus Conventional-Dose Methylprednisolone in Reducing the Risk of Chronic Lung Disease in Chinese Children With Severe Mycoplasma pneumoniae Pneumonia: A Retrospective Study.pubmed.ncbi.nlm.nih.gov
83. A nursing perspective on bronchoscopic intervention strategies for children with macrolide-unresponsive <i>Mycoplasma pneumoniae</i> pneumonia.pubmed.ncbi.nlm.nih.gov
84. Respiratory Morbidity After Repair of Type C Esophageal Atresia with Tracheoesophageal Fistula: A Pediatric Case Series.pubmed.ncbi.nlm.nih.gov
85. Imaging findings of multislice computed tomography in 21 patients with airway invasive pulmonary aspergillosis.pubmed.ncbi.nlm.nih.gov
86. Surgically Diagnosed Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia in Asymptomatic Patients.pubmed.ncbi.nlm.nih.gov
87. Clinical characteristics of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia.pubmed.ncbi.nlm.nih.gov
88. Rare clinical presentation of invasive pulmonary aspergillosis in patient with early-stage lung cancer: a case report.pubmed.ncbi.nlm.nih.gov
89. Humidifier lung and summer-type hypersensitivity pneumonitis in Japan: a nationwide retrospective observational study of clinical, radiological and pathological features.pubmed.ncbi.nlm.nih.gov
90. CT findings in biomass smoke-associated interstitial lung disease: A retrospective analysis.pubmed.ncbi.nlm.nih.gov
91. Pediatric lung ultrasound: Tips and tricks for better scanning and interpretation.pubmed.ncbi.nlm.nih.gov
92. The 2025 ATS/ERS update of the international multidisciplinary classification of the interstitial pneumonias: implications for the pathologist.pubmed.ncbi.nlm.nih.gov
93. Non-Linear Dysanaptic Lung Growth in Patients With Post-Infectious Bronchiolitis Obliterans.pubmed.ncbi.nlm.nih.gov
94. Research priorities in chronic lung allograft dysfunction: A machine learning-assisted bibliometric analysis.pubmed.ncbi.nlm.nih.gov
95. Bronchiolitis Obliterans Syndrome Following High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation in a Pediatric Patient With Neuroblastoma.pubmed.ncbi.nlm.nih.gov
96. Imaging of pediatric pulmonary infections: A pictorial review.pubmed.ncbi.nlm.nih.gov

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