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Mucoid Impactions: Finger-in-Glove Sign and Other CT and Radiographic Features¹

¹ From 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.); and Department 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 no financial relationships to disclose. Address correspondence to S.M. (e-mail: santiago.martinez{at}duke.edu).

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 opacities known 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