147 lines
10 KiB
Markdown
147 lines
10 KiB
Markdown
---
|
|
title: "Finger-in-Glove Sign"
|
|
docid: "81c5db2f-b8f6-4092-bcd2-ffb8aa3ab18a"
|
|
authors:
|
|
- key: "fa682303-6426-4b97-8c60-783051febb88"
|
|
value: "Jorge Alberto Carrillo-Bayona, MD"
|
|
breadcrumbs:
|
|
-
|
|
name: "Chest"
|
|
slug: "chest"
|
|
treeNodeId: "23b17a2b-c629-4f3b-b960-0bfdc5d138ca"
|
|
-
|
|
name: "Differential Diagnosis"
|
|
slug: "differential-diagnosis"
|
|
treeNodeId: "41e2b114-bb5b-4430-86a8-4c667ef0f50a"
|
|
-
|
|
name: "Airways"
|
|
slug: "airways"
|
|
treeNodeId: "dbd08dc8-069b-455c-af2f-73376c667e07"
|
|
-
|
|
name: "General Imaging Patterns"
|
|
slug: "general-imaging-patterns"
|
|
treeNodeId: "569ccd87-4cb8-4a9e-83f4-c8ac16b26c5e"
|
|
-
|
|
name: "Finger-in-Glove Sign"
|
|
slug: "finger-in-glove-sign"
|
|
treeNodeId: null
|
|
category: "Chest"
|
|
documentVersionId: "b09d26e0-dd26-493f-a120-ba11c7e04745"
|
|
imageCount: 8
|
|
lastUpdated: "02/10/20"
|
|
pageDescription: "Finger-in-Glove Sign"
|
|
pageKeywords: "Chest, Differential Diagnosis, Airways, General Imaging Patterns, Finger-in-Glove Sign"
|
|
pageTitle: "Finger-in-Glove Sign | STATdx"
|
|
enhancedTitle: "Finger-in-Glove Sign"
|
|
type: "DDX"
|
|
breadcrumbs:
|
|
- "Chest"
|
|
- "Differential Diagnosis"
|
|
- "Airways"
|
|
- "General Imaging Patterns"
|
|
- "Finger-in-Glove Sign"
|
|
---
|
|
# ESSENTIAL INFORMATION
|
|
|
|
- ## Key Differential Diagnosis Issues
|
|
|
|
|
|
- Finger-in-glove sign: Mucoid impaction with resultant dilated or impacted bronchi
|
|
- Bronchial obstruction: Atresia, foreign body, neoplasm
|
|
- Nonobstructive entities: Allergic bronchopulmonary aspergillosis, cystic fibrosis
|
|
- Radiography/CT: Branching tubular opacities that typically radiate from hilum toward lung periphery
|
|
- Differential diagnosis of bronchial branching tubular opacities
|
|
- Arteriovenous malformation
|
|
- Exhibits contrast enhancement
|
|
- Demonstrates afferent and efferent vessels: Feeding artery(ies) and draining vein(s)
|
|
- ## Helpful Clues for Common Diagnoses
|
|
|
|
|
|
- **Allergic Bronchopulmonary Aspergillosis**
|
|
- Immunologic disorder caused by hypersensitivity to*Aspergillus fumigatus*
|
|
- Predisposing conditions: Asthma, cystic fibrosis
|
|
- Laboratory findings: Positive aspergillus skin test, elevated IgE levels against *Aspergillus fumigatus*
|
|
- Total IgE levels > 1,000 IU/mL
|
|
- IgG antibodies against*A. fumigatus* in serum
|
|
- Total eosinophil count > 500 cells/mL
|
|
- Imaging: Branching tubular opacities, high attenuation on CT due to intrinsic calcium oxalate
|
|
- **Congenital Bronchial Atresia**
|
|
- Focal atresia of segmental bronchus
|
|
- Typically affects left upper lobe apicoposterior segment
|
|
- Recurrent infection in 20% of patients
|
|
- CT: Tubular or branching opacity surrounded by hyperlucent lung due to air-trapping and oligemia
|
|
- ## Helpful Clues for Less Common Diagnoses
|
|
|
|
|
|
- **Bronchiectasis**
|
|
- Cystic fibrosis
|
|
- Autosomal recessive disorder that affects regulation of chloride transport
|
|
- Recurrent infection, progressive bronchial wall injury
|
|
- Diffuse bronchiectasis (upper lobe predominant); central and peripheral airways affected
|
|
- Primary ciliary dyskinesia
|
|
- Structural abnormality that affects ciliary motion
|
|
- Bronchiectasis, sinusitis, infertility
|
|
- Basilar predominant airway involvement
|
|
- **Benign Airway Neoplasm**
|
|
- Hamartoma
|
|
- Endobronchial (1.4% of cases)
|
|
- Fat &/or calcification in endobronchial lesion supports diagnosis
|
|
- Lipoma
|
|
- Endobronchial lipoma (0.1-0.5% of lung tumors)
|
|
- Nonenhancing homogeneous fat attenuation lesion
|
|
- **Malignant Airway Neoplasm**
|
|
- Carcinoid tumor
|
|
- Low-grade neuroendocrine neoplasm
|
|
- Intrinsic calcification; may be eccentric
|
|
- Marked contrast enhancement
|
|
- Lung cancer
|
|
- Centrally obstructing mass
|
|
- Mucoid impaction uncommon
|
|
- **Foreign Body**
|
|
- Patients < 15 years of age (70%)
|
|
- Most frequent location: Right lower lobe bronchus and bronchus intermedius
|
|
- Adults: Chronic clinical course, recurrent pneumonia
|
|
|
|
|
|
## Images
|
|
|
|
|
|
### Selected Images
|
|
|
|
|
|
**Allergic Bronchopulmonary Aspergillosis**
|
|
*PA chest radiograph of a patient with asthma and allergic bronchopulmonary aspergillosis shows right basilar tubular opacities <img src='img/arrows/CS.png'/> corresponding to mucoid impaction in dilated airways.*
|
|
|
|
|
|
**Allergic Bronchopulmonary Aspergillosis**
|
|
*PA chest radiograph of a patient with asthma and allergic bronchopulmonary aspergillosis shows right basilar tubular opacities <img src='img/arrows/CS.png'/> corresponding to mucoid impaction in dilated airways.*
|
|
|
|
|
|
**Allergic Bronchopulmonary Aspergillosis**
|
|
*Coronal NECT of the same patient shows right basilar branching tubular opacities that correspond to right lower lobe bronchiectasis with intrinsic mucus plugs <img src='img/arrows/CS.png'/>. Impacted mucus may exhibit high attenuation. Allergic bronchopulmonary aspergillosis is due to hypersensitivity to fungal antigens.*
|
|
|
|
|
|
**Congenital Bronchial Atresia**
|
|
*Coronal CECT of a 27-year-old man with bronchial atresia shows a nonenhancing left upper lobe tubular opacity that corresponds to an atretic bronchus impacted with mucus <img src='img/arrows/CS.png'/>.*
|
|
|
|
|
|
**Congenital Bronchial Atresia**
|
|
*Coronal CECT of the same patient shows focal air-trapping <img src='img/arrows/CS.png'/> in the left upper lobe distal to the impacted atretic bronchus and mucocele. Bronchial atresia most frequently affects the left upper lobe apicoposterior bronchus. Affected patients are typically asymptomatic.*
|
|
|
|
|
|
**Bronchiectasis**
|
|
*Axial NECT of a 20-year-old man with cystic fibrosis shows multifocal bronchiectasis <img src='img/arrows/CS.png'/>, bronchial wall thickening, and soft tissue tubular opacities that correspond to impacted mucus <img src='img/arrows/CO.png'/> within dilated peripheral airways.*
|
|
|
|
|
|
**Bronchiectasis**
|
|
*Axial NECT of a 34-year-old-man with primary ciliary dyskinesia and Kartagener syndrome shows bilateral upper lobe branching tubular opacities <img src='img/arrows/CS.png'/> that correspond to impacted mucus within bronchiectatic airways. Note coexistent situs inversus and right aortic arch <img src='img/arrows/WC.png'/>.*
|
|
|
|
|
|
**Malignant Airway Neoplasm**
|
|
*Axial CECT of a patient with a history of chronic cough and blood-tinged sputum shows a polylobular middle lobe soft tissue mass <img src='img/arrows/CO.png'/> that exhibits an endobronchial component <img src='img/arrows/CS.png'/> and obstructs a small airway in the middle lobe. Carcinoid tumor was diagnosed at surgery.*
|
|
|
|
|
|
**Malignant Airway Neoplasm**
|
|
*Sagittal CECT of the same patient shows the centrally obstructing carcinoid tumor and peripheral mucoid impaction <img src='img/arrows/CS.png'/>. Carcinoid tumor is a low-grade malignant neoplasm with frequent endobronchial involvement.*
|
|
|