What does "tree-in-bud" pattern mean?

Posted by pennelope @pennelope, Mar 14 12:12am

What exactly does the following mean?
There are a few clusters of peripheral micronodules in the left lower lobe
laterally with a "tree-in-bud" pattern, likely sequelae from previous atypical
infection such as Mycobacterium avium complex

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@jnmy

You may want to try a huff cough to get up any mucus (from your throat) and more importantly any phlegm ( from your lungs). It may be something to ask your doctor if you have to wait any length of time before your pulmonologist appointment.

If they thought you had Bronchiectasis, hopefully they would recommend an airway clearance product such as the Aerobika, since you mention having a lot of phlegm. Just a thought.

I wonder if physicians are reluctant to suggest the Aerobika before a pulmonologist is seen. They are the specialists after all.

It is a rare disease and it is really hit or miss on whether a physician is even knowledgeable about the top five or six chronic lung diseases and their symptoms.

Perhaps they don’t know about the products. If that is the case, more awareness of BE and airway clearance would be helpful.

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Hi Penelope,
I have been going through this since September of last year. I have had 3 CT scans which showed a lot of tree buds and also one upper right nodule of 12 mm which is now 9.5 mm and a 19 mm lower right nodule treated with antibiotics and prednisone because it was thought to be an infection. Had a Bronchoscopy on 1/23/24 test for MAC and other things. Six weeks results said no MAC no bacteria. I thought six weeks was early to diagnose but was told that liquid mycobacterium cultures are only kept for six weeks. Sorry, I am rambling, I am still coughing like crazy and was sent to a allergist because of high eosinophils and Ige levels. Was told I have asthma due to allergies and was given an inhaler, that was yesterday! In the meantime, I still have two nodules that have not been biopsied because they believe it was a infection but there was no infection because courses of antibiotics did not work. I know asthma can cause coughing but I don’t know about nodules! Seeing pulmonary doctor on the 21st. I just don’t know to do anymore!

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@mcdc1959

Hi Penelope,
I have been going through this since September of last year. I have had 3 CT scans which showed a lot of tree buds and also one upper right nodule of 12 mm which is now 9.5 mm and a 19 mm lower right nodule treated with antibiotics and prednisone because it was thought to be an infection. Had a Bronchoscopy on 1/23/24 test for MAC and other things. Six weeks results said no MAC no bacteria. I thought six weeks was early to diagnose but was told that liquid mycobacterium cultures are only kept for six weeks. Sorry, I am rambling, I am still coughing like crazy and was sent to a allergist because of high eosinophils and Ige levels. Was told I have asthma due to allergies and was given an inhaler, that was yesterday! In the meantime, I still have two nodules that have not been biopsied because they believe it was a infection but there was no infection because courses of antibiotics did not work. I know asthma can cause coughing but I don’t know about nodules! Seeing pulmonary doctor on the 21st. I just don’t know to do anymore!

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Thank you!
Best wishes for your health.

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@mcdc1959

Hi Penelope,
I have been going through this since September of last year. I have had 3 CT scans which showed a lot of tree buds and also one upper right nodule of 12 mm which is now 9.5 mm and a 19 mm lower right nodule treated with antibiotics and prednisone because it was thought to be an infection. Had a Bronchoscopy on 1/23/24 test for MAC and other things. Six weeks results said no MAC no bacteria. I thought six weeks was early to diagnose but was told that liquid mycobacterium cultures are only kept for six weeks. Sorry, I am rambling, I am still coughing like crazy and was sent to a allergist because of high eosinophils and Ige levels. Was told I have asthma due to allergies and was given an inhaler, that was yesterday! In the meantime, I still have two nodules that have not been biopsied because they believe it was a infection but there was no infection because courses of antibiotics did not work. I know asthma can cause coughing but I don’t know about nodules! Seeing pulmonary doctor on the 21st. I just don’t know to do anymore!

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@mcdc1959 It's my understanding that since MAC is slow growing it takes at least 2 months to grow it in the lab from sputum culture. I did not know that the timing for cultures from bronchoscopy were different than sputum sample? That might be something to question pulmonary about, and/or I hope others could share their experience with timing around bronchoscopy cultures. I hope you get some answers.

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@scoop

@mcdc1959 It's my understanding that since MAC is slow growing it takes at least 2 months to grow it in the lab from sputum culture. I did not know that the timing for cultures from bronchoscopy were different than sputum sample? That might be something to question pulmonary about, and/or I hope others could share their experience with timing around bronchoscopy cultures. I hope you get some answers.

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Just checked pulmonary doctor exact words:
Liquid mycobacterium 6 weeks.
Solid media cultures in the past could be held till
8 weeks.

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@scoop

@mcdc1959 It's my understanding that since MAC is slow growing it takes at least 2 months to grow it in the lab from sputum culture. I did not know that the timing for cultures from bronchoscopy were different than sputum sample? That might be something to question pulmonary about, and/or I hope others could share their experience with timing around bronchoscopy cultures. I hope you get some answers.

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Scoop and @mcdc1959 - MAC grows within 6 weeks in the lab. Extra time is needed to perform sensitivity testing and, if necessary, strain isolation.
So, if there is nothing in 6 weeks, it is pretty certain there was none where sampled. If they did a bronchoscopy, especially with bronchial lavage, you can breathe a sigh of relief.
Sue

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@sueinmn

Scoop and @mcdc1959 - MAC grows within 6 weeks in the lab. Extra time is needed to perform sensitivity testing and, if necessary, strain isolation.
So, if there is nothing in 6 weeks, it is pretty certain there was none where sampled. If they did a bronchoscopy, especially with bronchial lavage, you can breathe a sigh of relief.
Sue

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Thank you, feel much better about the result now!

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