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Active Pulmonary Tuberculosis with Bronchial Spread

Imaging findings

CT shows extensive bilateral upper lobe cavitating consolidations and nodules, with peripheral tree-in-bud branching nodules representing active endobronchial spread of infection, in a patient presenting with weight loss and productive cough.

Key takeaways

Active pulmonary tuberculosis typically presents with upper lobe consolidations and cavitations. Endobronchial spread of the mycobacteria manifests on CT as branching centrilobular nodules (tree-in-bud pattern) at the periphery of consolidations.

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