Mucoid impaction (lung)

Mucoid impaction, also referred to as mucus plugging or bronchocoele, is a commonly encountered pathological feature seen in chest radiography and thoracic CT scanning. It is usually defined as airway filling by mucoid secretions and can be obstructive or nonobstructive. 

Pathology

Aetiology

Mucoid impaction may result from either obstructive or non-obstructive causes, although the latter do eventually obstruct the bronchi as well:

Non-obstructive

Non-obstructive causes are Infectious or inflammatory in nature:

Obstructive

Radiographic features

Plain radiograph

Mucoid impaction may appear as a branching tubular opacity that is distinct from the normal vascular shadows. It can sometimes prove difficult to diagnose on plain radiography.

CT

The radiographic appearance can be variable, depending on where the mucus plugging occurs (i.e. central or peripheral airways).

The classic feature seen when plugged mucus extends along large branching airways is the finger-in-glove sign.

Two key additional features can occur as well:

  • distal lung collapse: from collateral air drift; this has not yet developed in infants and young children, which is why the distal lung is rather hyperlucent in this population (e.g. congenital bronchial atresia, foreign body aspiration)
  • distal airway dilatation

Treatment and prognosis

 

Complications

Prolonged mucus plugging can lead to bronchial dilatation and bronchiectasis.

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Article information

rID: 31519
System: Chest
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:
  • Mucus plugging
  • Endoluminal mucus plugging
  • Impacted bronchial secretions
  • Mucoid impactions
  • Mucoid impaction

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Cases and figures

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    Case 1
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    Case 2: in left lower lobe bronchi
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    Case 3: in right lower lobe on plain film
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    Case 4: ABPA
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