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Plugs of the Air Passages: A Clinicopathologic Review

Tanmay S. Panchabhai, MD, FACP, FCCP; Sanjay Mukhopadhyay, MD; Sameep Sehgal, MD; Debabrata Bandyopadhyay, MD, MRCP, FACP; Serpil C. Erzurum, MD; Atul C. Mehta, MD, FACP, FCCP
Author and Funding Information

Conflict of interest statement: None of the authors who contributed to this manuscript have any conflicts of interest to disclose.

Author details:

Tanmay S. Panchabhai, MD, FACP, FCCP

Staff Pulmonologist

John and Doris Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Assistant Professor of Medicine, Creighton University School of Medicine Email: tanmay.panchabhai@dignityhealth.org

Sanjay Mukhopadhyay, MD

Staff Pathologist, Department of Pathology, Cleveland Clinic, Cleveland OH Email: mukhops@ccf.org

Sameep Sehgal, MD

Fellow, Department of Pulmonary Medicine

Respiratory Institute, Cleveland Clinic Email: sehgals@ccf.org

Debabrata Bandyopadhyay, MD, MRCP, FACP

Staff Pulmonologist

Department of Thoracic Medicine

Geisinger Medical Center, Danville, PA Email: dbandyopadhyay@geisinger.edu

Serpil C. Erzurum, MD

Chair, Department of Pathobiology, The Alfred Lerner Memorial Chair in Innovative Biomedical Research,

Lerner Research Institute, Cleveland Clinic

Staff Physician, Respiratory Institute, Email: erzurus@ccf.org

1Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ

2Department of Pathology, Cleveland Clinic, Cleveland, OH

3Respiratory Institute, Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH

4Department of Thoracic Medicine, Geisinger Medical Center, Danville, PA

5Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH

corresponding author: Atul C. Mehta, MD FACP, FCCP, Professor of Medicine, Lerner College of Medicine, Buoncore Family Endowed Chair in Lung Transplantation, Staff Physician, Respiratory Institute, Cleveland Clinic, Senior Editor, Journal of Bronchology & Interventional Pulmonology


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.07.003
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Abstract

Although mucus is a normal product of the tracheobronchial tree, some diseases of the respiratory tract are characterized by unusually thick (inspissated) forms of mucus that accumulate within the airways. These are known as mucus plugs. The pathologic composition of these plugs is surprisingly diverse and, in many cases, correlates with distinctive clinical, radiologic, and bronchoscopic findings. The best-known conditions that involve mucus plugs are allergic bronchopulmonary aspergillosis, plastic bronchitis, and asthma. Other lung diseases occasionally associated with plugs within the airways include Aspergillus tracheobronchitis, hyper-immunoglobulin E syndromes, exogenous lipoid pneumonia, pulmonary alveolar proteinosis, and chronic eosinophilic pneumonia. In this review, we describe and illustrate the bronchoscopic, pathologic, and imaging findings in respiratory disorders characterized by mucus plugs or plugs composed of other similar materials. Recognition of the characteristic appearance and differential diagnosis of mucus plugs will hopefully facilitate diagnosis and management of these diseases.


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