Tubular shadows of soft tissue opacity akin to gloved fingers are seen on thoracic radiographs (Figs. 11A, B) and CT (Fig. 11C) and typically originate in the upper lobes in a bronchial distribution.^2–4,36,37 The tubular, fingerlike projections represent dilated, mucoid-impacted bronchi surrounded by aerated lung. When an inciting stenosis or bronchial obstruction occurs, mucous glands will continue to produce fluid, while the secretions are continually taken to the site of narrowing by mucociliary transport.³⁸ As the secretions become inspissated, debris accumulates distal to the point of obstruction, and bronchiectasis ensues. Visualization of the gloved fingers is made possible by collateral air drift through the interalveolar pores of Kohn and canals of Lambert aerating lung distal to the point of mucoid impaction. There are 2 broad etiologic categories: non-obstructive and obstructive.³⁸ Non-obstructive causes, such as allergic bronchopulmonary aspergillosis (ABPA), asthma, or cystic fibrosis, are common considerations. ABPA is seen most commonly in asthmatic patients and occurs after inhaled Aspergillus organisms are trapped in airway mucus, triggering subsequent type I and type III allergic reactions.³⁸ The acute type I response results in bronchoconstriction, heightened vascular permeability, wall edema, and protracted mucus production, whereas the delayed type III response causes immunopathological damage to the involved bronchi.³⁸ Mucoid impaction in the setting of cystic fibrosis is secondary to mucociliary dysfunction and thick mucous secretions. Benign (bronchial hamartomas or lipomas) and malignant (bronchogenic carcinoma or carcinoid tumors) neoplasms are considerations in the obstructive category. Congenital obstructive causes, such as bronchial atresia, intralobar sequestration, or bronchogenic cysts, might also be considered.