Gloved finger signCervicothoracic sign

Dr Mazen QusaibatyMD, DIS

Head Pulmonary and Internist Department Ibnalnafisse Hospital

Ministry of Syrian healthEmail:

Qusaibaty@gmail.com

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Topic Outline

1. Gloved finger sign2. Cervicothoracic sign

Gloved finger sign القفاز إصبع عالمة

Gloved finger sign

• Refers to the branching finger like opacities.

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Gloved finger sign

• Gloved finger shadows" due to intrabronchial exudates with bronchial wall thickening

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Gloved finger sign

• These appear as branched tubular radiodensities:2 to 3 cm long5 to 8 mm wide that

extend from the hilus

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Gloved finger sign

• Representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery

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Schematic diagram depicts four grades of bronchial wall

thickening scores

Central bronchiectasis

• Central bronchiectasis in a patient with allergic bronchopulmonary aspergillosis

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Central bronchiectasis

• Multiple dilated third and fourth generation bronchi are seen.

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Central bronchiectasis

• Smaller peripheral bronchi filled with mucus account for the branching linear opacities in the distal lung parenchyma.

11 Courtesy of Paul Stark, MD

Gloved finger sign

Mucoid Impaction

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Gloved finger sign

Mucoid impaction of underlying bronchiectatic airway in a patient with Allergic BronchoPulmonary Aspergillosis (ABPA).

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Gloved finger sign

Mucoid impactions are:

A characteristic finding in ABPA

And typically occur distal to the diseased central airways.

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Gloved finger sign

Allergic bronchopulmonary

aspergillosis (ABPA)

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Gloved finger sign

• In Allergic Bronchopulmonary Aspergillosis

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• Close-up frontal radiograph of the right upper lobe obtained in a patient with asthma and allergic bronchopulmonary aspergillosis (ABPA)

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• Note the branching tubular opacities (arrows) emanating from the right hilum, which compose the gloved finger sign.

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Bronchial Atresia

• Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced (CT) of the chest just above the left hemidiaphragm

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• A tubular and a branching structure in the posterior basal segment of the LLL

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• A congenital atresia of this bronchus.

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• The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction

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Transverse CT image in 1-year-old boy

• A round opacity (arrow)

• An area of hypoattenuation (arrowheads) and decreased vascularity

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Transverse CT image in 1-year-old boy

• A congenital atresia of this bronchus

Bronchial atresia

• Bronchial atresia is a developmental anomaly

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Bronchial atresia

• Characterised by focal obliteration of the proximal segment of a bronchus

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Bronchial atresia

• It is typically at the:o Segmentalo Or subsegmental

levelo And most commonly

occurs in the upper lobes.

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Bronchial atresia

• The bronchi distal to the atresia become filled with mucus and may form a mucocoele

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Bronchial atresia

• The lung distal to the atretic bronchuso Develops normally

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Bronchial atresia

The lung distal is overinflated due to collateral air drift with air trapping.

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Bronchial atresia

• It may cause Shortness of

breath Cough Or rarely infection.

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Conclusion

• Gloved finger sign - indicates bronchial impaction, which can be seen in allergic bronchopulmonary aspergillosis

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Cervicothoracic signالصدرية الرقبية العالمة

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Cervicothoracic sign

A mediastinal opacity that projects above the clavicles is retrotracheal and posteriorly

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Cervicothoracic sign

while an opacity effaced along its superioraspect and projecting at or below the clavicles is situated anteriorly

Cervicothoracic sign

• This 74 year-old female presented with mild dyspnoea

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Cervicothoracic sign

A superior mediastinal massDisplaces the trachea to the right

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This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 39

This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 40

The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. 41

Positive Cervicothoracic sign (Ant)

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What is your diagnosis?

The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case.

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Cervicothoracic sign

This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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Negative Cervicothoracic sign

• This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

What is your diagnosis?

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Cervicothoracic sign

Neuroblastoma

This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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• This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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• This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal

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What is your diagnosis?

Schwannoma

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REFERENCES

• 1. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW.

Signs in thoracic imaging. J.Thorac.Imaging 2006;21:76-90

• 2. Webb WR. Thin-section CT of the secondary pulmonary

lobule: anatomy and the image—the 2004 Fleischner

lecture.Radiology. 2006 May;239(2):322-38

• 3. Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich

DP, Remy-Jardin M, Webb WR, Zerhouni EA. Glossary of

terms for CT of the lungs: recommendations of the

Nomenclature Committee of the Fleischner Society.

Radiology 1996;200(2):327-31

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