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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month - November 2017

This 70 year old female presented to the ED complaining of one day of cough, fever and chills. Because of some abnormalities on her chest x-ray, she underwent a chest CT.

Question 1 : What is the descriptive term often used by radiologists for the findings circled below?

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Answer 1:

The structures seen are usually referred to as “tree-in-bud.” These are usually seen at the periphery and appear somewhat like a branch which contains many small flowers at the end. This is due to impaction of the bronchioles.

Question 2: What causes this and what should you do next?
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Answer 2:

There are several illnesses which can cause this finding. The most common is infectious causes of bronchiolitis (including viral, bacterial, parasitic, mycobacterial and fungal.) Next steps depend on the patient’s clinical picture.

This patient was clinically stable and requesting to be discharged. She was sent home on prednisone, azithromycin, cefuroxime with expedited pulmonary follow up.

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