• Qi Li, Xiao Fan, Xing-Tao Huang, Tian-You Luo, Zhi-Gang Chu, Li Chen, Zhi-Wei Zhang, Yan-Qing Li, Jing-Quan Wu, Yu Ouyang, Fa-Jin Lv, and Chao-Hao Ma.
• Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China.
• Lung Cancer. 2015 Jun 1; 88 (3): 260-6.

ObjectivesTree-in-bud (TIB) pattern can be found with central lung cancer on chest CT scans. However, few reports have described it so far. We aim to determine its incidence, CT findings and pathologic basis.Materials And Methods652 consecutive patients with confirmed central lung cancer were enrolled in our study. The incidence, CT findings and pathologic features of TIB pattern were analyzed retrospectively.ResultsIn total, TIB pattern was found in 22.5% (147/652) of patients. It was more common in patients with squamous cell carcinoma than those with non-squamous cell carcinoma (P=0.000). The most important associated CT finding was obstructive bronchial mucoid impaction distal to the cancer (100%, 147/147), followed by consolidation and ground-glass opacities (62.6%, 92/147). TIB pattern was confined to the areas of lung supplied by the involved bronchi (100%, 147/147) and had a focal distribution predominantly (94.6%, 139/147). Pathologically, it correlated with bronchiolectasis, bronchiolar lumen filled by mucus and inflammatory exudates, wall thickening with inflammatory cells infiltration.ConclusionsTIB pattern is commonly detected in central lung squamous cell carcinoma on thoracic CT scan. It usually has a localized distribution with a predominant associated CT finding of obstructive bronchial mucoid impaction. This pattern corresponds to the mucoid impaction of bronchioles and bronchiolitis pathologically. A full understanding of TIB pattern in central lung cancer can be useful in preventing diagnostic errors.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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