CTICasesActive Tuberculosis with Post-Bronchoscopy Bronchial Spread
Imaging findings
Initial chest CT shows a dense consolidation in the right middle lobe with compressive right hilar and mediastinal lymphadenopathy, including a necrotic lymph node with caseous-appearing attenuation. Following bronchoscopy, a repeat chest CT shows rapid, diffuse, bilateral centrilobular nodules in a tree-in-bud pattern, representing extensive bronchogenic spread.
Key takeaways
Tuberculosis can present atypically as a lobar or segmental consolidation accompanied by necrotic lymph nodes. Performing bronchoscopy and bronchoalveolar lavage in these patients can mechanically spread highly infectious caseous material throughout the airways, resulting in rapid, florid, and diffuse tree-in-bud nodularity across both lungs.
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