A Bone marrow transplant recipient patientdeveloped chest infection. On HRCT ‘Tree in bud appearance’ is seen. Most likely causative agent is:
**Core Concept**
The "tree in bud" appearance on HRCT (High-Resolution Computed Tomography) is a radiological sign associated with bronchiolitis, specifically bronchiolitis obliterans. This condition involves inflammation and scarring of the bronchioles, which are small airways in the lungs. The "tree in bud" appearance is due to the presence of dilated bronchioles with peribronchiolar nodules.
**Why the Correct Answer is Right**
The "tree in bud" appearance is most commonly seen in patients with bronchiolitis obliterans, which can occur as a complication of bone marrow transplantation. This condition is characterized by chronic inflammation and scarring of the bronchioles, leading to airflow limitation. The presence of peribronchiolar nodules and dilated bronchioles on HRCT is consistent with bronchiolitis obliterans.
**Why Each Wrong Option is Incorrect**
**Option A:** This option might be a distractor because it is a common cause of respiratory infections. However, the "tree in bud" appearance is not typically seen in patients with viral infections such as influenza.
**Option B:** This option might be a distractor because it is a common cause of respiratory infections in immunocompromised patients. However, the "tree in bud" appearance is more specific to bronchiolitis obliterans than to viral pneumonia.
**Option C:** This option might be a distractor because it is a common cause of respiratory infections in immunocompromised patients. However, the "tree in bud" appearance is more specific to bronchiolitis obliterans than to fungal pneumonia.
**Clinical Pearl / High-Yield Fact**
The "tree in bud" appearance on HRCT is a classic sign of bronchiolitis obliterans, which can occur as a complication of bone marrow transplantation. This condition requires prompt recognition and treatment to prevent long-term lung damage.
**Correct Answer:** C. Pseudomonas aeruginosa