Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Luong D, Bell D, High attenuation mucus. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://radiopaedia.org/articles/81040
High-attenuation mucus (HAM) is a form of mucoid impaction which is often considered a characteristic and an "almost pathognomonic" feature of allergic bronchopulmonary aspergillosis (ABPA) (close to 100% specificity) 1.
It may be present in up to 28% of patients with allergic bronchopulmonary aspergillosis 2. It may be more common in patients with unilobar plugging.
Its exact basis is not clear but many consider hyperattenuating mucus attributed to the presence of calcium salts and metals (the ions of iron and manganese) or desiccated mucus.
CT
It can be either subjectively appreciated as mucus visually denser than the chest wall or paraspinal skeletal muscle or objectively defined on a CT as having an attenuation value >70 Hounsfield units.
Treatment and prognosis
Hyperattenuating mucus is considered an independent predictor of poorer outcomes in allergic bronchopulmonary aspergillosis.
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History and etymology
The occurrence of high attenuation mucoid impaction in ABPA was first described by Goyal et al.
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1. Agarwal R. High attenuation mucoid impaction in allergic bronchopulmonary aspergillosis. (2010) World journal of radiology. 2 (1): 41-3. doi:10.4329/wjr.v2.i1.41 - Pubmed
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2. Logan P et.al High-attenuation mucous plugging in allergic bronchopulmonary aspergillosis. (1996) Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes. doi: - Pubmed
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3. Agarwal R et.al, Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. (2007) Chest. doi:10.1378/chest.07-0808 - Pubmed
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4. Ritesh Agarwal, Ashutosh N. Aggarwal, Dheeraj Gupta. High-Attenuation Mucus in Allergic Bronchopulmonary Aspergillosis: Another Cause of Diffuse High-Attenuation Pulmonary Abnormality. (2012) American Journal of Roentgenology. 186 (3): 904. doi:10.2214/AJR.05.0125 - Pubmed
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5. Agarwal R, Khan A, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A. An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. (2010) PloS one. 5 (12): e15346. doi:10.1371/journal.pone.0015346 - Pubmed
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6. Shah R et.al. Beware of gloved fingers. (2013) Annals of the American Thoracic Society. doi:10.1513/AnnalsATS.201211-111OT - Pubmed
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7. Molinari M, Ruiu A, Biondi M, Zompatori M. Hyperdense mucoid impaction in allergic bronchopulmonary aspergillosis: CT appearance. (2004) Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. 61 (1): 62-4. Pubmed
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