Mucoid Impaction

Etiology

  • ABPA:
  • Asthma:
  • Chronic Bronchitis:
  • Cystic Fibrosis:
  • Distal to Central Airway Obstruction: associated with Bronchial Carcinoid, Bronchial Atresia, or Bronchial Cyst
  • BCG:
  • Lung Cancer:

Physiology

  • Mucoid impaction within proximal segment bronchus
  • Proximal bronchial dilatation and distention with thick secretions
  • Focal angiitis may also occur in the area

Diagnosis

  • Sputum Cult+Sens:
    -Aspergillus or other sporulating fungi are often found in the specimens

FOB:

CXR/Chest CT Pattern:
1) V-Shaped, Finger-Shaped, Y-Shaped Density: conforms with bronchial subdivision
-Upper lobe predilection
-Absence of calcification
-Air-fluid level may be present within the dilated bronchus, simulating cavitation
-Atelectasis (which may be extensive) may or may not be present distal to impaction
2) Cluster of Grapes Appearance:
-Upper lobe predilection with absence of calcification
4) Lung Nodule:
-Upper lobe predilection with absence of calcification

Sputum GS/Cult:
-Aspergillus or other sporulating fungi are often found in the specimens

Sputum Cult+Sens:
-Aspergillus or other sporulating fungi are often found in the specimens


Treatment

  • Usually Transient (but may persist for weeks-months, even grow in size)
  • After resolution, may leave residual cylindrical/saccular dilatation of bronchus

References

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