Diseases Involving the Central Bronchi: Multidetector CT for Detection, Characterization, and Differential Diagnosis.
Radiographics. 2018 Jan-Feb;38(1):58-59. doi: 10.1148/rg.2018170097. Theriault MM1, Eddy K1, Borgaonkar JN1, Babar JL1, Manos D1.
The bronchial tree can be challenging to evaluate with computed tomography (CT). The two main patterns of central endobronchial disease, focal endobronchial lesion and diffuse or multifocal bronchial wall thickening, are easily overlooked. Endobronchial disease can be difficult to recognize clinically. This online presentation provides a guide to the identification and differential diagnosis of central bronchial lesions, including wall thickening and endoluminal nodules. Diseases limited to the trachea or small airways and diseases characterized primarily by bronchiectasis are not included.
Ancillary CT findings such as postobstructive air trapping, consolidation, atelectasis, tree-in-bud nodularity, and bronchiectasis are often more easily identified than the endobronchial lesion itself (Figure). Whereas these CT findings are common and nonspecific, a central obstructing endobronchial lesion should be excluded when these findings are focal and/or persistent. The finger-in-glove sign is a classic sign of allergic bronchopulmonary aspergillosis (ABPA). When the finger-in-glove sign involves an isolated segment (unlike the bilateral multifocal pattern seen in ABPA), endobronchial tumor should be considered.