Gloved finger sign
Cervicothoracic sign
Dr Mazen Qusaibaty
MD, DIS
Head Pulmonary and
Internist Department
Ibnalnafisse Ho...
Topic Outline
1. Gloved finger sign
2. Cervicothoracic sign
2
Gloved finger sign
‫القفاز‬ ‫إصبع‬ ‫عالمة‬
Gloved finger sign
• Refers to the
branching finger like
opacities.
4
Gloved finger sign
• Gloved finger
shadows" due to
intrabronchial
exudates with
bronchial wall
thickening
5
Gloved finger sign
• These appear as
branched tubular
radiodensities:
2 to 3 cm long
5 to 8 mm wide that
extend from the...
Gloved finger sign
• Representing dilated
bronchi filled with
mucus (mucoid
impaction) radiating
from the hila
towards the...
8
Schematic
diagram depicts
four grades of
bronchial wall
thickening
scores
Central bronchiectasis
• Central bronchiectasis
in a patient with
allergic
bronchopulmonary
aspergillosis
9
Central bronchiectasis
• Multiple dilated third
and fourth generation
bronchi are seen.
10
Central bronchiectasis
• Smaller peripheral
bronchi filled with
mucus account for the
branching linear
opacities in the di...
Gloved finger sign
Mucoid Impaction
12
Gloved finger sign
Mucoid impaction of
underlying
bronchiectatic airway
in a patient with
Allergic
BronchoPulmonary
Asper...
Gloved finger sign
Mucoid impactions
are:
 A characteristic
finding in ABPA
 And typically occur
distal to the diseased
...
Gloved finger sign
Allergic
bronchopulmonary
aspergillosis (ABPA)
15
Gloved finger sign
• In Allergic Bronchopulmonary Aspergillosis
16
• Close-up frontal radiograph of the right upper lobe
obtained in a patient with asthma and allergic
bronchopulmonary aspe...
• Note the branching tubular opacities (arrows)
emanating from the right hilum, which compose the
gloved finger sign.
18
19
Bronchial Atresia
• Two contiguous 5-mm thick transverse images
obtained at contrast material-enhanced (CT)
of the chest just above the left...
• A tubular and a branching structure in the
posterior basal segment of the LLL
21
• A congenital atresia of this bronchus.
22
• The vessels in the lung surrounding the
mucoid impaction are decreased in size due to
hypoxic vasoconstriction
23
Transverse CT image in 1-year-old boy
• A round opacity (arrow)
• An area of
hypoattenuation
(arrowheads) and
decreased
va...
Transverse CT image in 1-year-old boy
• A congenital atresia
of this bronchus
25
Bronchial atresia
• Bronchial atresia is a
developmental
anomaly
26
Bronchial atresia
• Characterised by
focal obliteration of
the proximal
segment of a
bronchus
27
Bronchial atresia
• It is typically at the:
o Segmental
o Or subsegmental
level
o And most commonly
occurs in the upper
lo...
Bronchial atresia
• The bronchi distal to
the atresia become
filled with mucus
and may form a
mucocoele
29
Bronchial atresia
• The lung distal to the
atretic bronchus
o Develops normally
30
Bronchial atresia
 The lung distal is
overinflated due
to collateral air
drift with air
trapping.
31
Bronchial atresia
• It may cause
 Shortness of
breath
 Cough
 Or rarely infection.
32
Conclusion
• Gloved finger sign - indicates bronchial
impaction, which can be seen in allergic
bronchopulmonary aspergillo...
Cervicothoracic sign
‫الصدرية‬ ‫الرقبية‬ ‫العالمة‬
34
Cervicothoracic sign
35
A mediastinal opacity that projects above the clavicles
is retrotracheal and posteriorly
Cervicothoracic sign
36
while an opacity effaced along its superior
aspect and projecting at or below the clavicles is
sit...
Cervicothoracic sign
• This 74 year-old
female presented
with mild dyspnoea
37
Cervicothoracic sign
A superior mediastinal mass
Displaces the trachea to the right38
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....
Positive Cervicothoracic sign (Ant)
42
What is your diagnosis?
The most common anterior superior
mediastinal mass is a retrosternal goitre,
as in this case. 44
Cervicothoracic sign
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal45
Negative Cervicothoracic sign
• This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal46
What is your diagnosis?
Cervicothoracic sign
Neuroblastoma
48
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
49
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
50
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
51
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
52
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
53
This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
54
• This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
55
• This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
56
What is your diagnosis?
Schwannoma
58
REFERENCES
• 1. Marshall GB, Farnquist BA, MacGregor JH, Burrowes PW.
Signs in thoracic imaging. J.Thorac.Imaging 2006;21:...
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  • A Pictorial Review of “Signs in Thoracic Imaging” Karuppasamy, K.1, Abhyankar-Gupta, M.1, Fewins, H.1, Curtis, J.2 1The Cardiothoracic Centre - Liverpool NHS Trust, 2Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  • prominence : بروزRefers to the branching finger like opacities representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery; e.g. ABPA

  • prominence : بروزRefers to the branching finger like opacities representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery; e.g. ABPA

  • prominence : بروزRefers to the branching finger like opacities representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery; e.g. ABPA

  • prominence : بروزRefers to the branching finger like opacities representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery; e.g. ABPA

  • Central bronchiectasis in a patient with allergic bronchopulmonary aspergillosis. Multiple dilated third and fourth generation bronchi are seen. Smaller peripheral bronchi filled with mucus account for the branching linear opacities in the distal lung parenchyma. Courtesy of Paul Stark, MD
  • Central bronchiectasis in a patient with allergic bronchopulmonary aspergillosis. Multiple dilated third and fourth generation bronchi are seen. Smaller peripheral bronchi filled with mucus account for the branching linear opacities in the distal lung parenchyma. Courtesy of Paul Stark, MD
  • Central bronchiectasis in a patient with allergic bronchopulmonary aspergillosis. Multiple dilated third and fourth generation bronchi are seen. Smaller peripheral bronchi filled with mucus account for the branching linear opacities in the distal lung parenchyma. Courtesy of Paul Stark, MD
  • Mucoid Impaction. Mucoid impaction of underlying bronchiectatic airway in a patient with ABPA. Mucoid impactions are a characteristic finding in ABPA and typically occur distal to the diseased central airways. Tubular branching opacities extend from the hilum and form a "gloved-finger" appearance
  • Mucoid Impaction. Mucoid impaction of underlying bronchiectatic airway in a patient with ABPA. Mucoid impactions are a characteristic finding in ABPA and typically occur distal to the diseased central airways. Tubular branching opacities extend from the hilum and form a "gloved-finger" appearance
  • Mucoid Impaction. Mucoid impaction of underlying bronchiectatic airway in a patient with ABPA. Mucoid impactions are a characteristic finding in ABPA and typically occur distal to the diseased central airways. Tubular branching opacities extend from the hilum and form a "gloved-finger" appearance
  • The finger in glove sign seen on CXR and CT chest and refers to the characteristic sign of a bronchocoele, as seen in allergic bronchopulmonary aspergillosis (ABPA).  Rarely a similar appearance can occur with bronchial atresia. 
  • In allergic bronchopulmonary aspergillosis.

    The impacted bronchi appear radiographically as opacities with distinctive shapes.
  • Close-up frontal radiograph of the right upper lobe obtained in a patient with asthma and allergic bronchopulmonary aspergillosis (ABPA). Note the branching tubular opacities (arrows) emanating from the right hilum, which compose the gloved finger sign.
  • Close-up frontal radiograph of the right upper lobe obtained in a patient with asthma and allergic bronchopulmonary aspergillosis (ABPA). Note the branching tubular opacities (arrows) emanating from the right hilum, which compose the gloved finger sign.
  • Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced computed tomography (CT) of the chest just above the left hemidiaphragm show (a) a tubular and (b) a branching structure in the posterior basal segment of the left lower lobe due to a congenital atresia of this bronchus. The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction.
  • Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced computed tomography (CT) of the chest just above the left hemidiaphragm show (a) a tubular and (b) a branching structure in the posterior basal segment of the left lower lobe due to a congenital atresia of this bronchus. The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction.
  • Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced computed tomography (CT) of the chest just above the left hemidiaphragm show (a) a tubular and (b) a branching structure in the posterior basal segment of the left lower lobe due to a congenital atresia of this bronchus. The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction.
    رتق
  • Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced computed tomography (CT) of the chest just above the left hemidiaphragm show (a) a tubular and (b) a branching structure in the posterior basal segment of the left lower lobe due to a congenital atresia of this bronchus. The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction.
  • Transverse CT image in 1-year-old boy with known right lower lobe nodular lesion, representing mucus accumulation within the patent bronchus distal to the atretic segment, shows characteristic CT appearance of a congenital bronchial atresia manifested as a round opacity (arrow) associated with an area of hypoattenuation (arrowheads) and decreased vascularity. Note its somewhat atypical location, since congenital bronchial atresia is typically located in the apical or apicoposterior segment of the upper lobes.
  • Transverse CT image in 1-year-old boy with known right lower lobe nodular lesion, representing mucus accumulation within the patent bronchus distal to the atretic segment, shows characteristic CT appearance of a congenital bronchial atresia manifested as a round opacity (arrow) associated with an area of hypoattenuation (arrowheads) and decreased vascularity. Note its somewhat atypical location, since congenital bronchial atresia is typically located in the apical or apicoposterior segment of the upper lobes.
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus. It is typically at the segmental or subsegmental level and most commonly occurs in the upper lobes. The bronchi distal to the atresia become filled with mucus and may form a mucocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping. Bronchial atresia is usually asymptomatic, as with this case found incidentally on the CT chest of a trauma patient. If symptomatic, it may cause shortness of breath, cough or rarely infection.
    Reference: Berrocal T et al, Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology, Radiographics 2003;24:e1
  • Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced computed tomography (CT) of the chest just above the left hemidiaphragm show (a) a tubular and (b) a branching structure in the posterior basal segment of the left lower lobe due to a congenital atresia of this bronchus. The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction.
  • cervicothoracic sign - a mediastinal opacity that projects above the clavicles is
    retrotracheal and posteriorly situated while an opacity effaced along its superior
    aspect and projecting at or below the clavicles is situated anteriorly
    Cervicothoracic sign
    The anterior mediastinum stops at the level of the superior clavicle. Therefore, when a mass extends above the superior clavicle, it is located either in the neck or in the posterior mediastinum. When lung tissue comes between the mass and the neck, the mass is probably in the posterior mediastinum.  This is known as the Cervicothoracic Sign.
    If we study the image on the frontal view on the left, we see a mass extending above the level of the clavicle and there is lung tissue in front of it, so this must be a mass in the posterior mediastinum.
  • cervicothoracic sign - a mediastinal opacity that projects above the clavicles is
    retrotracheal and posteriorly situated while an opacity effaced along its superior
    aspect and projecting at or below the clavicles is situated anteriorly
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • This 74 year-old female presented with mild dyspnoea. The chest x-ray above shows a superior mediastinal mass which displaces the trachea to the right. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. Not all goitres are anterior - some may insinuate between trachea and oesophagus, in which case the margins are visible above the clavicles. Other anterior mediastinal masses (thymic tumours, germ cell tumours) tend to be more caudad. Lymphadenopathy in lymphoma may be at the same level.
    Reference: Gurney JW, Winer-Muram HT. PocketRadiologist Chest: Top 100 Diagnoses. Amirsys 2003
  • Cervicothoracic sign
    The anterior mediastinum stops at the level of the superior clavicle. Therefore, when a mass extends above the superior clavicle, it is located either in the neck or in the posterior mediastinum. When lung tissue comes between the mass and the neck, the mass is probably in the posterior mediastinum.  This is known as the Cervicothoracic Sign.
    If we study the image on the frontal view on the left, we see a mass extending above the level of the clavicle and there is lung tissue in front of it, so this must be a mass in the posterior mediastinum.
  • Cervicothoracic sign
    The anterior mediastinum stops at the level of the superior clavicle. Therefore, when a mass extends above the superior clavicle, it is located either in the neck or in the posterior mediastinum. When lung tissue comes between the mass and the neck, the mass is probably in the posterior mediastinum.  This is known as the Cervicothoracic Sign.
    If we study the image on the frontal view on the left, we see a mass extending above the level of the clavicle and there is lung tissue in front of it, so this must be a mass in the posterior mediastinum.
  • Cervicothoracic sign
    The anterior mediastinum stops at the level of the superior clavicle. Therefore, when a mass extends above the superior clavicle, it is located either in the neck or in the posterior mediastinum. When lung tissue comes between the mass and the neck, the mass is probably in the posterior mediastinum.  This is known as the Cervicothoracic Sign.
    If we study the image on the frontal view on the left, we see a mass extending above the level of the clavicle and there is lung tissue in front of it, so this must be a mass in the posterior mediastinum.
  • Cervicothoracic sign
    The anterior mediastinum stops at the level of the superior clavicle. Therefore, when a mass extends above the superior clavicle, it is located either in the neck or in the posterior mediastinum. When lung tissue comes between the mass and the neck, the mass is probably in the posterior mediastinum.  This is known as the Cervicothoracic Sign.
    If we study the image on the frontal view on the left, we see a mass extending above the level of the clavicle and there is lung tissue in front of it, so this must be a mass in the posterior mediastinum.
  • Cervicothoracic sign
    The anterior mediastinum stops at the level of the superior clavicle. Therefore, when a mass extends above the superior clavicle, it is located either in the neck or in the posterior mediastinum. When lung tissue comes between the mass and the neck, the mass is probably in the posterior mediastinum.  This is known as the Cervicothoracic Sign.
    If we study the image on the frontal view on the left, we see a mass extending above the level of the clavicle and there is lung tissue in front of it, so this must be a mass in the posterior mediastinum.
  • Gloved finger sign and cervicothoracic sign

    1. 1. Gloved finger sign Cervicothoracic sign Dr Mazen Qusaibaty MD, DIS Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health Email: Qusaibaty@gmail.com
    2. 2. Topic Outline 1. Gloved finger sign 2. Cervicothoracic sign 2
    3. 3. Gloved finger sign ‫القفاز‬ ‫إصبع‬ ‫عالمة‬
    4. 4. Gloved finger sign • Refers to the branching finger like opacities. 4
    5. 5. Gloved finger sign • Gloved finger shadows" due to intrabronchial exudates with bronchial wall thickening 5
    6. 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. 7. Gloved finger sign • Representing dilated bronchi filled with mucus (mucoid impaction) radiating from the hila towards the periphery 7
    8. 8. 8 Schematic diagram depicts four grades of bronchial wall thickening scores
    9. 9. Central bronchiectasis • Central bronchiectasis in a patient with allergic bronchopulmonary aspergillosis 9
    10. 10. Central bronchiectasis • Multiple dilated third and fourth generation bronchi are seen. 10
    11. 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. 12. Gloved finger sign Mucoid Impaction 12
    13. 13. Gloved finger sign Mucoid impaction of underlying bronchiectatic airway in a patient with Allergic BronchoPulmonary Aspergillosis (ABPA). 13
    14. 14. Gloved finger sign Mucoid impactions are:  A characteristic finding in ABPA  And typically occur distal to the diseased central airways. 14
    15. 15. Gloved finger sign Allergic bronchopulmonary aspergillosis (ABPA) 15
    16. 16. Gloved finger sign • In Allergic Bronchopulmonary Aspergillosis 16
    17. 17. • Close-up frontal radiograph of the right upper lobe obtained in a patient with asthma and allergic bronchopulmonary aspergillosis (ABPA) 17
    18. 18. • Note the branching tubular opacities (arrows) emanating from the right hilum, which compose the gloved finger sign. 18
    19. 19. 19 Bronchial Atresia
    20. 20. • Two contiguous 5-mm thick transverse images obtained at contrast material-enhanced (CT) of the chest just above the left hemidiaphragm 20
    21. 21. • A tubular and a branching structure in the posterior basal segment of the LLL 21
    22. 22. • A congenital atresia of this bronchus. 22
    23. 23. • The vessels in the lung surrounding the mucoid impaction are decreased in size due to hypoxic vasoconstriction 23
    24. 24. Transverse CT image in 1-year-old boy • A round opacity (arrow) • An area of hypoattenuation (arrowheads) and decreased vascularity 24
    25. 25. Transverse CT image in 1-year-old boy • A congenital atresia of this bronchus 25
    26. 26. Bronchial atresia • Bronchial atresia is a developmental anomaly 26
    27. 27. Bronchial atresia • Characterised by focal obliteration of the proximal segment of a bronchus 27
    28. 28. Bronchial atresia • It is typically at the: o Segmental o Or subsegmental level o And most commonly occurs in the upper lobes. 28
    29. 29. Bronchial atresia • The bronchi distal to the atresia become filled with mucus and may form a mucocoele 29
    30. 30. Bronchial atresia • The lung distal to the atretic bronchus o Develops normally 30
    31. 31. Bronchial atresia  The lung distal is overinflated due to collateral air drift with air trapping. 31
    32. 32. Bronchial atresia • It may cause  Shortness of breath  Cough  Or rarely infection. 32
    33. 33. Conclusion • Gloved finger sign - indicates bronchial impaction, which can be seen in allergic bronchopulmonary aspergillosis 33
    34. 34. Cervicothoracic sign ‫الصدرية‬ ‫الرقبية‬ ‫العالمة‬ 34
    35. 35. Cervicothoracic sign 35 A mediastinal opacity that projects above the clavicles is retrotracheal and posteriorly
    36. 36. Cervicothoracic sign 36 while an opacity effaced along its superior aspect and projecting at or below the clavicles is situated anteriorly
    37. 37. Cervicothoracic sign • This 74 year-old female presented with mild dyspnoea 37
    38. 38. Cervicothoracic sign A superior mediastinal mass Displaces the trachea to the right38
    39. 39. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 39
    40. 40. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 40
    41. 41. The margins of the mass fade out at the level of the clavicles, the cervicothoracic sign, indicating an anterior location. 41
    42. 42. Positive Cervicothoracic sign (Ant) 42
    43. 43. What is your diagnosis?
    44. 44. The most common anterior superior mediastinal mass is a retrosternal goitre, as in this case. 44
    45. 45. Cervicothoracic sign This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal45
    46. 46. Negative Cervicothoracic sign • This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal46
    47. 47. What is your diagnosis?
    48. 48. Cervicothoracic sign Neuroblastoma 48
    49. 49. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 49
    50. 50. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 50
    51. 51. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 51
    52. 52. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 52
    53. 53. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 53
    54. 54. This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 54
    55. 55. • This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 55
    56. 56. • This mediastinal mass is seen in A. Anterior mediastinal B. Posterior mediastinal 56
    57. 57. What is your diagnosis?
    58. 58. Schwannoma 58
    59. 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
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