title: Tree-in-bud sign as a manifestation of localized pulmonary lymphatic metastasis from a pancreas cancer.
abstract: The tree-in-bud appearance usually reflects benign disorders of the bronchovascular bundle. Pulmonary metastasis reportedly also shows a tree-in-bud pattern in cases of dilated peripheral pulmonary artery filled with intravascular tumor emboli or fibrocellular intimal hyperplasia of the small pulmonary arteries induced by tumor microemboli, or endobronchial metastatic disease. On X-ray CT, pulmonary metastases may result in four main types of imaging manifestations: nodules, lymphatic spread, tumor emboli, and endobronchial tumor, and show diffuse interstitial thickening or multiple nodules in general. We report a rare case of localized pulmonary peribronchovascular lymphatic tumor spread without intravascular tumor emboli from a pancreas cancer, which mimicked the localized vascular tree-in-bud sign.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Moon
authors.forename: Ho Yun
authors.initials: HY
authors.lastname: Lee
authors.forename: Joungho
authors.initials: J
authors.lastname: Han
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000098:blood supply / Q000556:secondary; D006801:Humans; D008175:Lung Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000556:secondary*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010190:Pancreatic Neoplasms; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed