Gloved finger sign and cervicothoracic sign

Gloved finger sign and Cervicothoracic sign

1. Gloved finger sign Cervicothoracic sign Dr Mazen Qusaibaty MD, DIS Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health Email: [email protected]

2. Topic Outline Gloved finger sign Cervicothoracic sign 2

3. Gloved finger sign علامة إصبع القفاز

4. Gloved finger sign Refers to the branching finger like opacities. 4

5. Gloved finger sign Gloved finger shadows" due to intrabronchial exudates with bronchial wall thickening 5

6. Gloved finger sign These appear as branched tubular radiodensities : 2 to 3 cm long 5 to 8 mm wide that extend from the hilus 6

7. Gloved finger sign Representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery 7

8. 8 Schematic diagram depicts four grades of bronchial wall thickening scores

9. Central bronchiectasis Central bronchiectasis in a patient with allergic bronchopulmonary aspergillosis 9

10. Central bronchiectasis Multiple dilated third and fourth generation bronchi are seen. 10

11. 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

12. Gloved finger sign Mucoid Impaction 12

13. Gloved finger sign Mucoid impaction of underlying bronchiectatic airway in a patient with A llergic B roncho P ulmonary A spergillosis (ABPA). 13

14. Gloved finger sign Mucoid impactions are: A characteristic finding in ABPA And typically occur distal to the diseased central airways. 14

15. Gloved finger sign Allergic bronchopulmonary aspergillosis (ABPA)   15

16. Gloved finger sign In Allergic Bronchopulmonary Aspergillosis 16

17. Close-up frontal radiograph of the right upper lobe obtained in a patient with asthma and allergic bronchopulmonary aspergillosis (ABPA) 17

18. Note the branching tubular opacities (arrows) emanating from the right hilum, which compose the gloved finger sign. 18

19. 19 Bronchial Atresia

20. Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced (CT) of the chest just above the left hemidiaphragm 20

21.   A tubular and a branching structure in the posterior basal segment of the LLL 21

22. A congenital atresia of this bronchus. 22

23. The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction 23

24. Transverse CT image in 1-year-old boy A round opacity (arrow) An area of hypoattenuation (arrowheads ) and decreased vascularity 24

25. Transverse CT image in 1-year-old boy A congenital atresia of this bronchus 25

26. Bronchial atresia Bronchial atresia is a developmental anomaly 26

27. Bronchial atresia Characterised by focal obliteration of the proximal segment of a bronchus 27

28. Bronchial atresia It is typically at the: Segmental Or subsegmental level And most commonly occurs in the upper lobes. 28

29. Bronchial atresia The bronchi distal to the atresia become filled with mucus and may form a mucocoele 29

30. Bronchial atresia The lung distal to the atretic bronchus Develops normally 30

31. Bronchial atresia The lung distal is overinflated due to collateral air drift with air trapping. 31

32. Bronchial atresia It may cause Shortness of breath Cough Or rarely infection. 32

33. Conclusion Gloved finger sign - indicates bronchial impaction, which can be seen in allergic bronchopulmonary aspergillosis 33

34. Cervicothoracic sign العلامة الرقبية الصدرية 34

35. Cervicothoracic sign 35 A mediastinal opacity that projects above the clavicles is retrotracheal and posteriorly

36. Cervicothoracic sign 36 while an opacity effaced along its superior aspect and projecting at or below the clavicles is situated anteriorly

37. Cervicothoracic sign This 74 year-old female presented with mild dyspnoea 37

38. Cervicothoracic sign A superior mediastinal mass Displaces the trachea to the right 38

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

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

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

42. Positive Cervicothoracic sign (Ant) 42

43. What is your diagnosis?

44. The most common anterior superior mediastinal mass is a retrosternal goitre , as in this case. 44

45. Cervicothoracic sign This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 45

46. Negative Cervicothoracic sign This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 46

47. What is your diagnosis?

48. Cervicothoracic sign Neuroblastoma 48

49. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 49

50. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 50

51. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 51

52. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 52

53. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 53

54. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 54

55. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 55

56. This mediastinal mass is seen in Anterior mediastinal Posterior mediastinal 56

57. What is your diagnosis?

58. Schwannoma 58

59. 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 59