An unusual cause of 'tree-in-bud' appearance in CT-chest during COVID-19 pandemic

Monaldi Arch Chest Dis. 2020 Sep 4;90(3). doi: 10.4081/monaldi.2020.1466.

Abstract

'Tree-in-bud' (TIB) appearance in computed tomography (CT) chest is most commonly a manifestation of infection. We here describe an unusual cause of TIB during the COVID-19 pandemic. A young male patient who had a history of fever, cough, and respiratory distress presented in the emergency department. As these symptoms matched with coronavirus infection, the COVID-19 test was done, which was found negative. He was then moved to the intensive care unit where he developed severe acute respiratory distress syndrome and was put on mechanical ventilation. Further workup did not reveal any source of infection, as all his cultures were negative, but his CT chest showed a tree-in-bud appearance. After obtaining a detailed history from his friends, the patient was found a chronic abuser of inhaled cocaine and treated with intravenous steroids. Subsequently, he was weaned from the ventilator and discharged from the intensive care unit after becoming asymptomatic.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Betacoronavirus
  • COVID-19
  • Cocaine Smoking / adverse effects*
  • Cocaine-Related Disorders / complications
  • Cocaine-Related Disorders / diagnosis*
  • Coronavirus Infections / diagnosis*
  • Diagnosis, Differential
  • Glucocorticoids / therapeutic use
  • Humans
  • Lung / diagnostic imaging*
  • Lung Injury / diagnostic imaging*
  • Lung Injury / etiology
  • Lung Injury / therapy
  • Male
  • Methylprednisolone / therapeutic use
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Respiration, Artificial
  • Respiratory Distress Syndrome / diagnostic imaging*
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / therapy
  • SARS-CoV-2
  • Tomography, X-Ray Computed

Substances

  • Glucocorticoids
  • Methylprednisolone