Finger in Glove Appearance

Robert B. Carr, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Finger in glove refers to mucoid impaction with dilation of large bronchi resulting in tubular or branching opacities
Initially described in patients with allergic bronchopulmonary aspergillosis (ABPA)
Tubular opacities seen on radiography may be bronchial or vascular in origin
Can be confused with arteriovenous malformation on radiography
CT reveals low-attenuation mucus in dilated central bronchi, thus differentiating from vascular causes

Helpful Clues for Common Diagnoses

Allergic Bronchopulmonary Aspergillosis
- Hypersensitivity reaction to Aspergillus antigens, usually A. fumigatus
- Usually occurs in patients with asthma or cystic fibrosis
- Associated with elevated IgE levels and peripheral eosinophilia
- Usually affects upper lobes
- Secretions may be hyperattenuating on CT due to presence of calcium oxalate
Congenital Bronchial Atresia
- Due to congenital atresia of segmental bronchus
- Usually incidental finding but may cause recurrent infections in 20% of patients
- Most common in apicoposterior segment of left upper lobe, followed by right upper lobe
- CT reveals surrounding pulmonary hyperlucency due to air-trapping and oligemia

Helpful Clues for Less Common Diagnoses

Cystic Fibrosis
- Congenital disease caused by chloride channel mutation on chromosome 7
- Recurrent infections lead to progressive bronchial wall injury
- CT findings include bronchiectasis, mucoid impaction, peribronchial thickening, mosaic perfusion, and tree in bud opacities
Obstructing Mass
- Rare benign endobronchial tumors include lipoma, papilloma, and hamartoma
- Malignant tumors are more common, including carcinoid, bronchogenic carcinoma, and endobronchial metastasis
- Obstructing tumor may be directly visualized on CT