Mucoid Impaction of the Bronchi

Abstract

Summary Seven cases illustrating the syndrome of mucoid impaction of bronchi are described. The syndrome seems to be confined to asthmatics. It may be clinically silent for long periods, or it may lead to bronchiectasis, pulmonary infection and hæmoptysis. Radiologically it may show both peripheral and hilar components. Diagnostically it may be confused with pulmonary tuberculosis, neoplasm or Loeffler's syndrome. Treatment is primarily medical. Adrenal corticoids may aggravate infection and are contraindicated. Surgical resection may be necessary to remove areas of destroyed lung or when a differentiation from bronchial carcinoma is impossible on clinical grounds. Lobectomy was performed in two cases only in this series, and the examination of operation specimens showed bronchi occluded by eosinophilic mucous material. There was inflammation with disorganization of the bronchial walls, and the alveoli showed collapse and lipoid pneumonia. It is considered that the syndrome described represents a more benign and localized variant of the widespread mucus obstruction of small bronchi found in fatal cases of status asthmaticus, and that both have their basis in a quantitative or qualitative disorder of bronchial mucus secretion in asthmatics. This disorder may be present even when clinical asthma is temporarily absent.

Allergic aspergillosis: review of 32 cases

“…Opaque dilated bronchi, radiating from the hilum and characteristic of mucoid impaction of the bronchi as described by Shaw (1951) and by Harvey, Blacket, and Read (1957), were seen in over a third of the present cases. They were found in areas of previous peripheral shadowing associated with distal saccular bronchiectasis; locally impaired bronchial drainage from prior lung damage may therefore have contributed to their formation.…”

“…In previous reviews of mucoid impaction (Shaw, 1951 ;Harvey et al, 1957) and of pulmonary eosinophilia and asthma (Crofton, Livingstone, Oswald, and Roberts, 1952;Young, 1955), the opacities were also found to occur most commonly in the upper lobes; earlier reports of these conditions may well have included unrecognized cases of allergic aspergillosis.…”

“…However, secondary bacterial infection probably accounts in some patients for the fever which is often associated and may respond to antibiotics, for the pleurisy which sometimes occurs, and for the sudden release of pus and resolution of the shadow following expectoration of a plug that has been reported in cases of allergic aspergillosis and of mucoid impaction (Plummer, 1958;Harvey et al, 1957). Cystic areas were noted in the affected segments in some of the present cases; Shaw (1951) has described abscess cavities distal to mucoid impaction.…”

“…It probably represents a late stage of the condition, although proof of this requires more prolonged observation of known cases. It is of interest that Harvey et al (1957) (Pepys, 1966a, b). A bronchial reaction may, however, be mediated by reagins alone.…”

Dosage of Griseofulvin

“…The congenital abnormalities in this baby are the same as those described by Lenz,,2 Pfeiffer and Kosenow,3 4 Wiedemann,5 and McBride6-namely, symmetrical aplasia and hypoplasia of the extremities. Their reports from West Germany and Australia include several hundred congenitally deformed infants born to mothers taking thalidomide.…”