Tubular Mass

Jonathan H. Chung, MD

DIFFERENTIAL DIAGNOSIS

Common

Bronchiectasis (with Mucous Plugging)
- Cystic Fibrosis
- Allergic Bronchopulmonary Aspergillosis
Endobronchial Tumor (with Distal Mucous Plugging)
Pulmonary Laceration

Less Common

Rare but Important

ESSENTIAL INFORMATION

Helpful Clues for Common Diagnoses

Cystic Fibrosis
- Diffuse, upper lung preponderant bronchiectasis, bronchial wall thickening
- Mucous plugging in medium and large airways
- Mosaic lung attenuation
Allergic Bronchopulmonary Aspergillosis
- Occurs in cystic fibrosis and asthma
- Central bronchiectasis in multiple lobes
- Mucous-filled bronchi; may have gas-fluid level
Endobronchial Tumor (with Distal Mucous Plugging)
- Slow-growing tumor, aspirated foreign body, broncholithiasis
- Results in distal bronchiectasis ± mucous plugging, air-trapping
Pulmonary Laceration
- Tubular lacerations more common with penetrating injuries (e.g., knife, bullets)
- Laceration initially blood-filled (hematoma)
- May have oblong or tubular configuration

Helpful Clues for Less Common Diagnoses

Pulmonary AVM
- Single or multiple nodules with feeding artery or arteries and draining vein
- Lower lung and medial lungs
- History of hereditary hemorrhagic telangiectasia

Helpful Clues for Rare Diagnoses

Scimitar Vein
- Anomalous pulmonary vein from right lung; drains into IVC
- Hypoplastic right lung; systemic arterial supply common; ± hypoplastic pulmonary artery
- Bronchial anomalies common: Bilobed right lung, bronchial diverticula, horseshoe lung
Bronchial Atresia
- Congenital atresia of segmental bronchus
- Left upper lobe (most common), right upper lobe, lower lobes
- Bronchocele: Mucoid impaction in obstructed bronchus
- Hyperlucency and paucity of vessels within affected segment