CTICasesDiffuse Bronchiolitis (Suspected Later-Onset Cystic Fibrosis)
Imaging findings
Chest CT demonstrates extensive bilateral tree-in-bud nodularity with branching centrilobular nodules, most pronounced in the lower lobes. There is minimal larger-airway bronchiectasis and mild bronchial wall thickening, along with a few surrounding ground-glass nodules. The pancreas appears normal and well-preserved.
Key takeaways
Diffuse centrilobular tree-in-bud nodularity on imaging is most commonly caused by infectious processes or aspiration. When symptoms are chronic or recurrent without an obvious acute cause, clinicians must investigate secondary etiologies including atypical infections like non-tuberculous mycobacteria, late-onset cystic fibrosis, allergic bronchopulmonary aspergillosis, primary ciliary dyskinesia, or immunodeficiencies. Diagnosing these underlying conditions requires a comprehensive multidisciplinary approach incorporating sweat chloride testing, genetic mutational analysis, immunoglobulin levels, and serial sputum cultures.
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