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

@pennelope
Welcome to Connect!
The imaging report describes a group of very tiny nodules in the left lower lobe- it looked like scarring from a past infection with a type of Mycobacterium.
There are several types of Mycobacterium- one being tuberculosis. However, this did not look like the pattern of the
Tb bacterium.
Have you been ill?

I had double pneumonia a month or so ago and was treated with antibiotics and steroids.
So the tree in bud is a normal thing????
They have referred me to a pulmonary specialist.
My test just said ABNORMAL and then the following
impression:%0A1.%20The%20previously%20seen%20lingular%20infiltrate%20and%20multifocal%20groundglass%20infiltrates%20scattered%20throughout%20the%20lungs%20bilaterally%20have%20resolved.%0A2.%20There%20are%20a%20few%20clusters%20of%20peripheral%20micronodules%20in%20the%20left%20lower%20lobe%20laterally%20with%20a%20'tree-in-bud%22%20pattern,%20likely%20sequelae%20from%20previous%20atypical%20infection%20such%20as%20Mycobacterium%20avium%20complex.

HI Pennelope, and welcome to our group - your discussion was moved here because the x-ray or CT findings you posted suggest you may have had the infection known as MAC (mycobacterium avium complex) in the past. "Tree in bud" and "ground glass infiltrates" are both signs that you may have had either other bouts of pneumonia or MAC infecting your lungs over time. This often occurs in conjunction with another condition known as bronchiectasis that can affect your lungs in ways similar to asthma or COPD.

It is a really good thing your are being referred to a pulmonologist. The "next steps" will probably include a CT scan, some pulmonary function tests, and if the doc suspects an underlying (sometimes called "smoldering") infection, a sputum culture to see what is hiding in your lungs.

Here are some questions you can think about asking the pulmonologist when you see them - be sure to take along someone to take notes for you, or a paper and pencil to write things down. It will also be helpful to your doctor if you keep a diary of symptoms you may be having like cough, congestion, mucus, fatigue or fever.
https://www.bronchiectasisandntminitiative.org/Learn-More/I-am-a-Patient-or-Caregiver/Newly-Diagnosed

As you begin the journey toward finding out whether you have a chronic condition or infection, our members can help you make sense of all the new terms you may here.

Do you have a history of pneumonia, bronchitis, asthma or COPD?

Sue

Tree in bud does not always mean MAC. It can also occur as a result of asthma. In their reports, radiologists try to be helpful to the referring doctor by making hypotheses about what they see, like tree in bud. Once a doctor friend told me that the "state bush of radiologists is the hedge!"

So in your opinion, a second option is warranted?

Not necessary to ask for 2nd option yet because you have not gotten to the bottom of what's causing the tree-in-bud. In other words, you have not gotten first opinion yet! Definitely see the pulmonologist for a workup. He/she will render an opinion/diagnosis. What @sueinmn suggested is standard workup -- CT scan, sputum test, spirometry aka pulmonary function tests. Good luck with everything. There are lots of people here who have been through what you going through. When/if you have questions come back and all will help you!

Thank you

My tree in bud was said in the report to be "evidence of prior granulomitous (sp?) disease" so it could be anything. I don't have MAC

Thank you!
No history of repeated pneumonia, etc.
I seem to have lots of congestion/Phlegm
lately.
When I first lay down at night I seem to cough for quite some time.
Last night I actually finally got back up and ate some ice chips.

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.