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:
Qusaibaty@gmail.com

2. Topic Outline
1. Gloved finger sign
2. Cervicothoracic sign
2

3. Gloved finger sign
‫القفاز‬ ‫إصبع‬ ‫عالمة‬

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
Allergic
BronchoPulmonary
Aspergillosis (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:
o Segmental
o Or subsegmental
level
o 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
o 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
‫الصدرية‬ ‫الرقبية‬ ‫العالمة‬
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 right38

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

40. This mediastinal mass is seen in
A. Anterior mediastinal
B. 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
A. Anterior mediastinal
B. Posterior mediastinal45

46. Negative Cervicothoracic sign
• This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal46

47. What is your diagnosis?

48. Cervicothoracic sign
Neuroblastoma
48

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

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

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

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

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

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

55. • This mediastinal mass is seen in
A. Anterior mediastinal
B. Posterior mediastinal
55

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