Mucoid impaction (lung)
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- updated 16 Jan 2023:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
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Mucoid impaction, also referred to as mucus plugging, mucous plugging, bronchial mucocele or bronchocele formation, refers to airway filling by retained secretions. When the bronchi become dilated due to mucoid secretions and impaction, the term bronchocele can be obstructive or non-obstructive. It is a common pathological finding in chest imagingused 6.
Pathology
Aetiology
Mucoid impaction may result from either obstructive or non-obstructive causes, although the latter does eventually obstruct the bronchi as well:
Non-obstructive
Non-obstructive causes are infectious or inflammatory in nature:
cystic fibrosis: due to impaired ciliary movement and thick secretions
asthma: due to increased mucus production
allergic bronchopulmonary aspergillosis (ABPA) - can sometimes have high attenuation mucoid impaction
Obstructive
-
congenital
congenital bronchial atresia: most commonly affects the apicoposterior segment of the left upper lobe
intralobar sequestration
intrapulmonary bronchogenic cyst
-
neoplastic
-
other acquired conditions
Radiographic features
Plain radiograph
Mucoid impaction may appear as a branching tubular opacity that is distinct from the normal vascular shadows. This classic feature is the finger-in-glove sign and is also seen on CT. It can sometimes prove difficult to diagnose on plain radiography.
CT
The appearance on CT can be variable, depending on where the mucous plugging occurs (i.e. central or peripheral airways).
Mucous plugs appear as fluid density material often located dependently within the bronchus, sometimes with internal gas.
The classic feature seen when plugged mucus extends along large branching airways is the finger-in-glove sign.
Several key additional features can also occur:
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)
Treatment and prognosis
Complications
Prolonged mucous plugging can lead to bronchial dilatation and bronchiectasis.
Differential diagnosis
endobronchial blood or blood clot appears similar to mucous plugging on CT
in some situations, there can be overlap between some endobronchial tumours per se (rather than with associated mucoid impaction)
-<p><strong>Mucoid impaction</strong>, also referred to as <strong>mucus plugging, mucous plugging, bronchial mucocele</strong> or <strong>bronchocele formation</strong>, refers to airway filling by mucoid secretions and can be obstructive or non-obstructive. It is a common pathological finding in chest imaging.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Mucoid impaction may result from either obstructive or non-obstructive causes, although the latter does eventually obstruct the bronchi as well:</p><h6>Non-obstructive</h6><p>Non-obstructive causes are infectious or inflammatory in nature:</p><ul>-<li>-<a href="/articles/cystic-fibrosis">cystic fibrosis</a>: due to impaired ciliary movement and thick secretions</li>-<li>-<a href="/articles/asthma-1">asthma</a>: due to increased mucus production</li>-<li>-<a href="/articles/allergic-bronchopulmonary-aspergillosis">allergic bronchopulmonary aspergillosis (ABPA)</a> - can sometimes have <a href="/articles/high-attenuation-mucoid-impaction">high attenuation mucoid impaction</a>-</li>-</ul><h6>Obstructive</h6><ul>-<li>congenital<ul>-<li>-<a href="/articles/bronchial-atresia">congenital bronchial atresia</a>: most commonly affects the apicoposterior segment of the left upper lobe</li>-<li>intralobar <a href="/articles/pulmonary-sequestration">sequestration</a>-</li>-<li>intrapulmonary <a href="/articles/bronchogenic-cyst">bronchogenic cyst</a>-</li>-</ul>-</li>-<li>neoplastic<ul>-<li>benign<ul>-<li><a href="/articles/bronchial-hamartoma">bronchial hamartoma</a></li>-<li><a href="/articles/lipoma">bronchial lipoma</a></li>-<li><a href="/articles/tracheo-bronchial-papillomatosis">tracheobronchial papillomatosis</a></li>-</ul>-</li>-<li>malignant<ul>-<li><a href="/articles/lung-cancer-3">bronchogenic carcinoma</a></li>-<li><a href="/articles/bronchial-carcinoid-tumour">bronchial carcinoid</a></li>-<li>-<a href="/articles/endobronchial-metastases">endobronchial metastases</a> <sup>5</sup>-</li>-</ul>-</li>-</ul>-</li>-<li>other acquired conditions<ul>-<li><a href="/articles/broncholithiasis">broncholithiasis</a></li>-<li><a href="/articles/tuberculous-bronchostenosis">tuberculous bronchostenosis</a></li>-<li><a href="/articles/airway-foreign-bodies-in-children">foreign body aspiration</a></li>-</ul>-</li>-</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Mucoid impaction may appear as a branching tubular opacity that is distinct from the normal vascular shadows. This classic feature is the <a href="/articles/finger-in-glove-sign-lung">finger-in-glove sign</a> and is also seen on CT. It can sometimes prove difficult to diagnose on plain radiography.</p><h5>CT</h5><p>The appearance on CT can be variable, depending on where the mucous plugging occurs (i.e. central or peripheral airways).</p><p>Mucous plugs appear as fluid density material often located dependently within the bronchus, sometimes with internal gas.</p><p>The classic feature seen when plugged mucus extends along large branching airways is the <a href="/articles/finger-in-glove-sign-lung">finger-in-glove sign</a>.</p><p>Several key additional features can also occur:</p><ul>-<li>distal lung collapse: from <a href="/articles/collateral-air-drift">collateral air drift</a>; 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)</li>-<li><a href="/articles/distal-airway-dilatation">distal airway dilatation</a></li>-<li>-<a href="/articles/double-artery-sign">double artery sign</a><sup> 9</sup>-</li>-</ul><h4>Treatment and prognosis</h4><h5>Complications</h5><p>Prolonged mucous plugging can lead to bronchial dilatation and <a href="/articles/bronchiectasis">bronchiectasis</a>.</p><h4>Differential diagnosis</h4><ul>-<li>-<a href="/articles/endobronchial-blood">endobronchial blood</a> or blood clot appears similar to mucous plugging on CT</li>-<li>in some situations, there can be overlap between some <a href="/articles/tracheal-and-endobronchial-lesions">endobronchial tumours</a> per se (rather than with associated mucoid impaction)</li>- +<p><strong>Mucoid impaction</strong>, also referred to as <strong>mucous plugging</strong>, refers to airway filling by retained secretions. When the <a href="/articles/tracheobronchial-tree" title="Tracheobronchial tree">bronchi</a> become dilated due to mucoid impaction, the term <strong>bronchocele </strong>can be used <sup>6</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Mucoid impaction may result from either obstructive or non-obstructive causes, although the latter does eventually obstruct the bronchi as well:</p><h6>Non-obstructive</h6><p>Non-obstructive causes are infectious or inflammatory in nature:</p><ul>
- +<li><p><a href="/articles/cystic-fibrosis">cystic fibrosis</a>: due to impaired ciliary movement and thick secretions</p></li>
- +<li><p><a href="/articles/asthma-1">asthma</a>: due to increased mucus production</p></li>
- +<li><p><a href="/articles/allergic-bronchopulmonary-aspergillosis">allergic bronchopulmonary aspergillosis (ABPA)</a> - can sometimes have <a href="/articles/high-attenuation-mucoid-impaction">high attenuation mucoid impaction</a></p></li>
- +</ul><h6>Obstructive</h6><ul>
- +<li>
- +<p>congenital</p>
- +<ul>
- +<li><p><a href="/articles/bronchial-atresia">congenital bronchial atresia</a>: most commonly affects the apicoposterior segment of the left upper lobe</p></li>
- +<li><p>intralobar <a href="/articles/pulmonary-sequestration">sequestration</a></p></li>
- +<li><p>intrapulmonary <a href="/articles/bronchogenic-cyst">bronchogenic cyst</a></p></li>
- +</ul>
- +</li>
- +<li>
- +<p>neoplastic</p>
- +<ul>
- +<li>
- +<p>benign</p>
- +<ul>
- +<li><p><a href="/articles/bronchial-hamartoma">bronchial hamartoma</a></p></li>
- +<li><p><a href="/articles/lipoma">bronchial lipoma</a></p></li>
- +<li><p><a href="/articles/tracheo-bronchial-papillomatosis">tracheobronchial papillomatosis</a></p></li>
- +</ul>
- +</li>
- +<li>
- +<p>malignant</p>
- +<ul>
- +<li><p><a href="/articles/lung-cancer-3" title="Lung cancer">lung cancer</a></p></li>
- +<li><p><a href="/articles/bronchial-carcinoid-tumour">bronchial carcinoid</a></p></li>
- +<li><p><a href="/articles/endobronchial-metastases">endobronchial metastases</a> <sup>5</sup></p></li>
- +</ul>
- +</li>
- +</ul>
- +</li>
- +<li>
- +<p>other acquired conditions</p>
- +<ul>
- +<li><p><a href="/articles/broncholithiasis">broncholithiasis</a> <sup>6</sup></p></li>
- +<li><p><a href="/articles/tuberculous-bronchostenosis">tuberculous bronchostenosis</a></p></li>
- +<li><p><a href="/articles/airway-foreign-bodies-in-children">foreign body aspiration</a></p></li>
- +</ul>
- +</li>
- +</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Mucoid impaction may appear as a branching tubular opacity that is distinct from the normal vascular shadows. This classic feature is the <a href="/articles/finger-in-glove-sign-lung">finger-in-glove sign</a> and is also seen on CT. It can sometimes prove difficult to diagnose on plain radiography.</p><h5>CT</h5><p>The appearance on CT can be variable, depending on where the mucous plugging occurs (i.e. central or peripheral airways).</p><p>Mucous plugs appear as fluid density material often located dependently within the bronchus, sometimes with internal gas.</p><p>The classic feature seen when plugged mucus extends along large branching airways is the <a href="/articles/finger-in-glove-sign-lung">finger-in-glove sign</a>.</p><p>Several key additional features can also occur:</p><ul>
- +<li><p>distal lung collapse: from <a href="/articles/collateral-air-drift">collateral air drift</a>; 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)</p></li>
- +<li><p><a href="/articles/distal-airway-dilatation">distal airway dilatation</a></p></li>
- +<li><p><a href="/articles/double-artery-sign">double artery sign</a><sup> 9</sup></p></li>
- +</ul><h4>Treatment and prognosis</h4><h5>Complications</h5><p>Prolonged mucous plugging can lead to bronchial dilatation and <a href="/articles/bronchiectasis">bronchiectasis</a>.</p><h4>Differential diagnosis</h4><ul>
- +<li><p><a href="/articles/endobronchial-blood">endobronchial blood</a> or blood clot appears similar to mucous plugging on CT</p></li>
- +<li><p>in some situations, there can be overlap between some <a href="/articles/tracheal-and-endobronchial-lesions">endobronchial tumours</a> per se (rather than with associated mucoid impaction)</p></li>
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