Abnormal Chest Roentgenogram Induced by Bronchial Involvement-Bronchial Cast Shadow

Abstract

We found rod-like shadows suggesting bronchial involvement in bronchial atresia, allergic bronchopulmonary aspergillosis, bronchiectasis, bronchial stenosis, bronchogenic carcinoma and mucoviscidosis. Typical cases are presented. Various nomenclatures of bronchial involvement based on radiological features or pathological states, such as gloved-finger, tooth-paste shadow, bronchial mucocele and mucoid impaction, are clinically used. We propose "bronchial cast shadow" as an unified term for the roentgenologic diagnosis of these various conditions. The purpose of this paper is; 1) From the radiologic diagnostic stand of view, mucoid impaction of bronchial mucocele is inappropriate, because the same radiologic appearance is not necessarily caused by impacted mucus. In some disorders, the contents of the bronchial lumen might be pus, blood or cells. Initially the abnormal shadow should be described according to the radiologic features, then the pathology of the shadow should be considered. 2) Several different terms are currently used for the same condition. The use of an unified terminology would be convenient for roentgen diagnosis. 3) The recognition of bronchial cast shadow is useful for differential diagnosis of abnormal shadows in the lungs and understanding of abnormal findings. When the bronchial cast shadow is recognized, the underlying cause of it must be determined.