Gallegos Lara

EDUCATION EXHIBIT 1369
Santiago Martinez, MD • Laura E. Heyneman, MD • H. Page McAdams,
MD • Santiago E. Rossi, MD • Carlos S. Restrepo, MD • Andres Eraso, MD
Mucoid impaction is a relatively common finding at chest radiography
and computed tomography (CT). Both congenital and acquired
abnormalities may cause mucoid impaction of the large airways that
often manifests as tubular opacitiesknown as the finger-in-glove sign.
The congenital conditions in which this sign most often appears are
segmental bronchial atresia and cystic fibrosis. The sign also may be
observed in many acquired conditions, include inflammatory and
infectious diseases (allergic bronchopulmonary aspergillosis, broncholithiasis,
and foreign body aspiration), benign neoplastic processes
(bronchial hamartoma,lipoma, and papillomatosis), and malignancies
(bronchogenic carcinoma, carcinoid tumor, and metastases). To point
to the correct diagnosis, the radiologist must be familiar with the key
radiographic and CT features that enable differentiation among the
various likely causes. CT is more useful than chest radiography for differentiating
between mucoid impaction and other disease processes,such as arteriovenous malformation, and for directing further diagnostic
evaluation. In addition, knowledge of the patient’s medical history,
clinical symptoms and signs, and predisposing factors is important.
©RSNA, 2008 • radiographics.rsnajnls.org
Mucoid Impactions:
Finger-in-Glove Sign
and Other CT and Radiographic
Features1
LEARNING
OBJECTIVES
FOR TEST 4
After reading this
articleand taking
the test, the reader
will be able to:
■■Recognize common
and uncommon
causes of mucoid
impaction.
■■Describe the
most frequent radiographic
and CT
manifestations of
each disorder.
■■Discuss other ancillary
findings commonly
seen in each
disorder.
Abbreviations: ABPA = allergic bronchopulmonary aspergillosis, PA = posteroanterior
RadioGraphics 2008; 28:1369–1382 •Published online 10.1148/rg.285075212 • Content Codes:
1From the Department of Radiology, Box 3808, Duke University Medical Center, Erwin Rd, Durham NC 27710 (S.M., L.E.H., H.P.M.); Department
of Radiology, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina (S.E.R.); Department of Radiology, University of Texas
Health Science Center at San Antonio, San Antonio, Tex (C.S.R.); andDepartment of Radiology, U.S. Department of Veterans Affairs Medical Center,
Washington, DC (A.E.). Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received November 12, 2007; revision requested
January 11, 2008; final revision received March 26; accepted April 7. H.P.M. received funding from General Electric Company and owns stock in Boston
Scientific; remaining authors have nofinancial relationships to disclose. Address correspondence to S.M. (e-mail: santiago.martinez@duke.edu).
©RSNA, 2008
See last page
TEACHING
POINTS
CME FEATURE
See accompanying
test at http://
www.rsna.org
/education
/rg_cme.html
Note: This copy is for your personal non-commercial use only. To order presentation-ready
copies for distribution to your colleagues or clients, contact us atwww.rsna.org/rsnarights.
1370 September-October 2008 RG ■ Volume 28 • Number 5
Introduction
Mucoid impaction is a relatively common finding
at chest radiography and computed tomography
(CT) and is associated with a wide variety of diseases.
The disease processes that may cause mucoid
impaction have been variously categorized
as obstructive versus nonobstructive (1) or congenital
versusacquired. We have used a hybrid
approach to classification that is based both on
the origin (congenital or acquired) and the nature
(inflammatory, infectious, or neoplastic) of the
specific disease process (Table 1).
The radiographic appearance of mucoid
impaction is variable. In the large airways, the
condition is classically manifested by tubular or
branching opacities that resemble...