The vascular “tree-in-bud” appearance has been recently described by Brijesh Patel from the Royal Brompton in London and his colleagues. This refers to the presence of branching peripheral vessels, in a way, similar to the bronchial “tree-in-bud” (top left) we see with infectious bronchiolitis / tuberculosis. This vascular “tree-in-bud” (top right) is supposedly a marker of a thrombotic vasculopathy with angiogenesis and micro-thromboses. The presence of this sign in admitted patients resulted in poorer prognosis in their study (AJRCCM. 2020 Jul 15;rccm.202004-1412OC).
India is unique among many countries that non-admitted, less symptomatic or sometimes pre and asymptomatic individuals get CT scans done. Here is one such patient who had a few foci of Covid-19 pneumonia (bottom left), one of which showed a vascular “tree-in-bud” (bottom right). She recovered without any complications.