A 67-year-old patient with bronchiectasis, diagnosed at age 4, presented with worsening dyspnoea and hypoxia. Chest radiograph revealed finger in glove appearance in left lung and large cystic spaces at lung bases (Fig 1). A subsequent computed tomography scan ruled out pulmonary embolism; however, it showed the following interesting radiological features consistent with cystic-cylindrical bronchiectasis and bronchocoeles:
Bunch of grapes sign1 – refers to dilated bronchi lying in close approximation giving the appearance of clusters of thin walled cysts (Figs 2 and 3). Similar appearances have also been described in hydatidiform mole and intraductal papillary mucinous neoplasm.
Finger in glove sign2 – refers to dilated bronchi filled with mucus/mucoid impaction and are seen as opacities originating from hila directed peripherally (Figs 2 and 4).
Bronchial arterial hypertrophy due to broncho-pulmonary shunting (Fig 5).
Fig 1.
Chest X-ray showing finger in glove sign (green arrow) and cystic spaces at lung bases (red arrow).
Fig 2.
Coronal section of CT thorax showing finger in glove (green arrow) and bunch of grapes sign (red arrow).
Fig 3.
CT section showing clusters of thin walled cystic spaces lying in close approximation ‘bunch of grape sign’.
Fig 4.
CT section showing dilated bronchi filled with mucous (red arrow).
Fig 5.
CT section showing bronchial artery hyperplasia (red arrow).
Competing interests
The authors declare no competing interests.
Acknowledgements
Written informed consent was obtained from the patient to publish the clinical details and images in this article.
References
- 1.Naidich DP. Webb WR. Müller NL. Vlahos I. Krinsky GA. Computed tomography and magnetic resonance of the thorax. 4th. Philadelphia:: Lippincott Williams & Wilkins; 2007. [Google Scholar]
- 2.Nguyen ET. The gloved finger sign. Radiology. 2003;227:453–4. doi: 10.1148/radiol.2272011548. [DOI] [PubMed] [Google Scholar]