A 67-year-old ex-smoker was referred for a right upper lung mass that had permeated the right upper bronchus, extended endo-bronchially, and dilated the distal airways, producing the “finger-in-glove” sign (Picture A, arrow). A bronchoscopic examination revealed total occlusion of the right superior lobar bronchus by an easily bleeding polypoid mass (Picture B), and biopsies cytologically demonstrated adenocarcinoma. Positron emission tomography-computed tomography (PET-CT) revealed the endobronchial mass to be fluorodeoxyglucose (FDG)-avid (Picture C), and the patient underwent curative surgery. Pathologically, the endobronchial mass contained viable tumor cells with patchy necrosis but no mucoid impaction, ultimately resulting in a diagnosis of endobronchial metastasis of renal cell carcinoma (Picture D). The “finger-in-glove” sign refers to branching tubular opacities that extend peripherally from the direction of the hilum. While it mostly implies benign endobronchial lesions, such as mucoid impaction, it may occasionally imply neoplastic disorders (1). Benign lesions are usually avascular and marginally FDG-avid, if at all; however, entirely FDG-avid “finger-in-glove” findings may encourage direct exploration of a potential malignant process (2).
Picture.
The authors state that they have no Conflict of Interest (COI).
References
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