Pulmonary Procedures |

Utility of Bronchoscopy in Patients With Tree-in-Bud Appearance on Computerized Tomography (CT) of Chest FREE TO VIEW

Vikas Pathak; Anna Conterato; Katherine Birchard; Robert Aris
Author and Funding Information

Pulmonary/Critical Care Medicine, University of North Carolina, Morrisville, NC

Chest. 2014;146(4_MeetingAbstracts):727A. doi:10.1378/chest.1988310
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SESSION TITLE: Bronchoscopy Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of the study was to retrospectively look at the usefulness of bronchoscopy in diagnosis and management of patients who had tree in bud appearance on CT of the chest.

METHODS: We did a retrospective chart review of all the patients over last 10 years who had tree in bud (TIB) appearance on CT chest. We compared the patients who had bronchoscopy for the diagnosis of TIB (group 1) vs. patients who had TIB appearance on CT chest but did not undergo bronchoscopy (group 2).

RESULTS: There were 19 patients in group 1, their mean age was 55 years +/- 16 (SD), with 12 females and 7 males. These 19 patients had a total of 63 CT scans among them with mean of 3.3 per patient. The mean follow up was 4.6 years +/- 2.6 SD. The mean FEV1 in this group was 70% predicted +/- 21 SD. The diagnosis in group 1 was infection in 13/19 patient (MAC 9, Aspergillosis 1, viral infection 3 and ORSA 1 patient). Aspiration, sarcoidosis, PCD and GVHD was found in one each. There were 21 patients in group 2. The mean age was 62 years +/- 14 (SD), there were 12 females and 9 males. There were total 57 CT scans with mean of 2.7 scans per patient. The mean follow up was 4.5 years +/- 2.3 SD. The mean FEV1 was 72% predicted +/- 22 SD. In terms of diagnosis, 8/21 patients had infection (7 patients with MAC and 1 had Coccidioidomycosis), 7/21 patients had recurrent aspiration pneumonia, one had BOOP and in 5 patients the etiology was unknown.

CONCLUSIONS: The patients with plain tree in bud appearance on the CT chest do not need bronchoscopy for diagnosis because sputum cultures alone are usually sufficient. MAC and recurrent aspiration are the most common etiologies.

CLINICAL IMPLICATIONS: Bronchoscopy can be avoided in patients with plain tree in bud appearance on CT chest.

DISCLOSURE: The following authors have nothing to disclose: Vikas Pathak, Anna Conterato, Katherine Birchard, Robert Aris

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