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Thrombotic Microangiopathy of Pulmonary Tumors: A Vascular Cause of Tree-In-Bud Pattern on CT

Tomás Franquet1, Ana Giménez1, Rosa Prats1, José Manuel Rodríguez-Arias2 and Carmen Rodríguez3

1 Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Avda Sant Antoni Ma Claret 167, 08025 Barcelona, Spain.
2 Department of Respiratory Medicine, Hospital de Sant Pau, Universidad Autónoma de Barcelona, 08025 Barcelona, Spain.
3 Department of Pathology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, 08025 Barcelona, Spain.



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  		Fig. 1A. —48-year-old man with thrombotic microangiopathy of pulmonary tumor induced by gastric adenocarcinoma. Magnified high-resolution CT images of both lower lobes obtained using 1-mm collimation and lung window settings show multiple centrilobular nodules and branching lines with tree-in-bud appearance (arrows).

 


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  		Fig. 1B. —48-year-old man with thrombotic microangiopathy of pulmonary tumor induced by gastric adenocarcinoma. Magnified high-resolution CT images of both lower lobes obtained using 1-mm collimation and lung window settings show multiple centrilobular nodules and branching lines with tree-in-bud appearance (arrows).

 


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  		Fig. 1C. —48-year-old man with thrombotic microangiopathy of pulmonary tumor induced by gastric adenocarcinoma. Photograph of cut section of lung from autopsy specimen shows normal interlobular septa (arrowheads) and pulmonary veins (PV) in periphery of secondary pulmonary lobule. Multiple branching opacities can be seen in central portion of lobule.

 


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  		Fig. 1D. —48-year-old man with thrombotic microangiopathy of pulmonary tumor induced by gastric adenocarcinoma. Photomicrograph of histopathologic specimen shows complete arteriolar occlusion by fibrocellular intimal proliferation. Clumps of tumor cells are visible in recanalized organized lesion. (H and E, x40)

 

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