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Can Respir J Vol 22 No X Month 2015 1
IMAGES IN RESPIRATORY MEDICINE
©2015 Pulsus Group Inc. All rights reserved
Finger-in-glove sign in congenital bronchial atresia
Miguel Ariza-Prota MD1, José Luis Diez Jarilla MD, Amador Prieto MD2,
Ana Pando-Sandoval MD1, Pere Casan MD1
1Hospital Universitario Central de Asturias (HUCA). Instituto Nacional de Silicosis (INS). Área del Pulmón. Facultad de Medicina.
Universidad de Oviedo. Oviedo. España; 2Hospital Universitario Central de Asturias (HUCA). Departamento de Radiología. Oviedo, España.
Correspondence: Dr Miguel Angel Ariza Prota, Instituto Nacional de Silicosis (INS), Área del Pulmón, Hospital Universitario Central de Asturias
(HUCA), Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias 33011, Spain.
Telephone 34-69006806, e-mail arizamiguel@hotmail.com
A
60-year-old woman was referred to the authors’ hospital in 2012,
with a three-month history of nonproductive cough. She had no
chest pain, night sweats or fever. She had no known toxic habits, nor
surgical or medical background of interest. The chest x-ray showed loss
of normal lung markings in the left upper lobe and a rounded, branch-
ing opacity mass lesion in the area of the left hilum (finger-in-glove
sign) (Figure 1A). A computed tomography scan of the chest showed
mucoid impactation, segmental hyperlucency and decreased vascular-
ity of the left upper lobe (Figure 1B). Three-dimensional reconstruc-
tion of the bronchial tree revealed an atretic apicoposterior segmental
bronchus of the left upper lobe confirming the diagnosis of congenital
bronchial atresia (Figure 1C).
KEY LEARNING POINTS
• Congenital bronchialatresiaisarareanomaly characterized by
normal bronchial ramification from a central blind bronchial sac
filled with mucus (mucocoele). The regional hyperinflation is due
to a check valve mechanism in the collateral ventilation through
the alveolar pores of Kohn, the bronchoalveolar channels of
Lambert, or the interbronchiolar channels.
• Distaltothebronchialatresiasecretionsaccumulate,leadingto
mucoid impaction surrounded by segmental hyperlucency
caused by a combination of trapped air and oligaemia.
• Theapicoposteriorsegmentalbronchusoftheleftupperlobeis
most commonly affected.
• Sixtypercentofpatientsareasymptomatic,theiranomalybeing
discovered on a routine chest radiograph.
• Computed tomography (with contrast if necessary) is the
diagnostic test of choice.
• Thedifferentialdiagnosisoffinger-in-glovesignincludesmucus
impaction due to cystic fibrosis, allergic bronchopulmonary
asperigillosis, broncholithiasis, foreign body aspiration and
malignancies.
REFERENCES
1. Nussbaumer-Ochsner Y, Kohler M. Finger-in-glove sign in bronchial
atresia. Thorax 2011;66:182.
2. Jederlinic PJ, Sicilian LS, Baigelman W, Gaensler EA. Congenital
bronchial atresia. A report of 4 cases and a review of the literature.
Medicine 1986;65:73-83.
3.MartinezS,HeynemanL,McAdamsH,etal.Mucoidimpactions:
Finger-in-glove sign and other CT and radiographic features.
Radiographics 2008;28:1369-82.
Figure 1) A Posteroanterior radiograph showing loss of normal lung markings in the left upper lobe and a rounded, branching opacity mass lesion (glove-in-
finger sign) in the area of the left hilum (white arrow). B Axial computed tomography image revealing mucoid impaction, segmental hyperlucency and decreased
vascularity in the left upper lobe. C Three-dimensional reconstruction of the bronchial tree (arrow). No division of the corresponding bronchi, confirming the
diagnosis of left upper lobe congenital bronchial atresia (arrows)
The ‘Images in Respiratory Medicine’ section of the Canadian
Respiratory Journal aims to highlight the importance of visual inter-
pretation, whether physiological, radiological, bronchoscopic, sur-
gical/thorascopic or histological, in the diagnosis of chest diseases.
Submissions should exemplify a classic, particularly dramatic or
intriguing presentation of a disease while offering an important
educational message to the reader (insightful diagnostic pearls or
differential diagnosis, etc). This section is not intended to be a
vehicle for publication of case reports (see the Clinical-Pathologic-
Conferences for case-based leaning series).
A B C