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Tree-in-bud opacities — SCE Respiratory MCQ

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HardImagingTree-in-bud opacitiesSCE Respiratory

A 63-year-old woman with bronchiectasis has weight loss and chronic cough. HRCT shows centrilobular nodules with branching linear opacities in the right middle lobe and lingula. Sputum cultures are pending, and there is no dominant lung mass. She has no history of aspiration. What is the most likely underlying cause?

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Correct answer: E — Endobronchial spread of infection causing tree-in-bud change

The best answer is “Endobronchial spread of infection causing tree-in-bud change”. The clinical pattern, physiology and imaging described are most consistent with Endobronchial spread of infection causing tree-in-bud change. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Pulmonary oedema with septal lines”, “UIP pattern fibrosis, after specialist assessment”, “Pleural plaques from asbestos exposure”, “Pulmonary embolic infarction, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society pulmonary nodule guideline: https://thorax.bmj.com/content/70/Suppl_2/ii1