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The gloved finger sign.

The branching tubular or fingerlike opacities extending out from the hila represent dilated bronchi filled with mucus (mucoid impaction). The mucoid impaction within a bronchus creates the appearance of a gloved finger. Once bronchial obstruction has occurred, the mucous glands continue to secrete until the bronchial pressure exceeds the secretory pressure. Mucous secretions are transported by ciliary action up to the site of the obstruction (2). The secretions become inspissated, and the mucus and inflammatory debris accumulate distal to the bronchial obstruction, thus causing bronchial dilatation (3). The dilated, mucus-filled bronchi are not visible at radiography if the surrounding lung is collapsed and airless. In patients with the gloved finger sign, the lung distal to the mucoid impaction remains aerated by collateral air drift through the interalveolar pores and the canals of Lambert, which allows the dilated bronchi to be seen as tubular branching opacities (4). The gloved finger sign can also be seen in conditions that do not involve bronchial obstruction, provided that the bronchi are dilated with secretions.