Characteristics

• Mucoid impaction from accumulated inspissated secretions within the bronchial lumen. Usually associated with bronchial dilatation.

• Associated with bronchial obstruction – neoplasm, adenoma and atresia.

• Associated without bronchial obstruction – asthma, cystic fibrosis and infection.

Clinical features

• Variable symptoms including shortness of breath, cough, purulent sputum and haemoptysis. Some patients may be asymptomatic (e.g. bronchial atresia).

• There may be history of chronic illness.

Radiological features

• CXR – the lesion may be solitary or multiple, often measuring in excess of 1 cm in diameter with branching ‘fingers’ extending towards the periphery, the so-called gloved finger shadow. There may be air trapping and lucency distal to the bronchocele. Sometimes the obstructing lesion produces lung collapse, making it impossible to identify the bronchocele on CXRs.

• CT – confirms the plain film changes with dilated mucus-filled bronchi ± distal air trapping. The CT is very good for identifying obstructing neoplastic masses and demonstrating bronchoceles in a region of lung collapse.

Differential diagnosis

• The different potential causes of bronchoceles. A good clinical history coupled with cross-sectional imaging is usually diagnostic.

Management

• Removal of the obstructing lesion may be necessary. Bronchoscopy is a useful way of removing large mucus plugs and obtaining a tissue diagnosis from neoplastic masses.

• Non-obstructing lesions require physiotherapy and antibiotic administration.