Question: nodules, plugs & tree-in-bud, oh my??

Posted by lvnl @lvnl, Mar 9 10:03am

Hi all, here's a question that's been on my mind: when nodules and "tree-in-bud" are seen on the CT, is that inflamed tissue? can they be plugs (impacted/stuck mucus)? Can plugs and nodules be mistaken for each other on CT, or do they look different on CT? Or do plugs not show up at all on CT?
I have MAC dx July 2024, w/ nodules & bronchiectasis on CT scan since 2012, never connected "nodules" and "bronchiectasis" until getting in to NYU Bronchiectasis & MAC program & coming here. The nodules have come, gone, been of different sizes, overall are stable. A larger one showing up in the last year had disappeared 6 months later. Due for another CT scan soon I think.
Thanks for any insight and best wishes to all for fuller understanding and better healing.

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Sue, Volunteer Mentor | @sueinmn | Mar 9 7:55pm

@lvnl1 I'm no radiologist, but I'll try to explain these as my pulmonologist described them.
Nodules are separate small structures on the CT, usually round, but sometimes oval and at other times "spiculated" meany bumpy on the outside-as if they had little spurs or projections on them.
Round ones may be signs of a past or present lung infection. Spiculated ones may be a sign of infection or, in high risk people, of cancer.
Nodules occur in many people, and few are even aware they exist. If you are asymptomatic, they are usually just watched over time for changes.

Tree in bud and mucus plugs are two descriptions for the same feature-small airways with small swollen areas, eitherjust at the tips, or along the airway. These are signs of thick mucus not quite making it out of the lungs. Airway clearance with saline is helpful for thinning and expelling these to make breathing easier.

I too have nodules that come and go - in my case, the better my asthma is controlled, the smaller they become.