Allergic Bronchopulmonary Aspergillosis (ABPA)
Clinical Information:
This 35 year old female has had asthma since age 3.
Exacerbations of her asthma were frequent and characterized
by sudden onset of malaise, pleuritic chest pain, cough, and
wheezing. She was diagnosed with ABPA at age 23 after a
work-up identified increased serum IgE, increased serum
eosinophils, positive skin test to Aspergillus, and proximal
bronchiectasis.
Imaging:
The CXR shows bronchial wall thickening and impressive central
bronchiectasis.
The CT demonstrates varicoid and cystic central bronchiectasis
in all 5 lobes and mucous plugging.
Discussion:
ABPA was first described by Hinson in the United Kingdom in
1952. Diagnostic criteria for ABPA include the presence of
asthma,a history of pulmonary infiltrates, peripheral blood
eosinophilia, immediate-type skin reactivity, serum
precipitating antibodies toAspergillus-specific IgE and IgG
and central (proximal) bronchiectasis. The disease is being
recognized more frequentlydue to increased physician
awareness and better diagnostic techniques.
Bronchiectasis alone may be present in patients with asthma
not complicated by ABPA but it is uncommon for asthmatics
withoutABPA to have severe forms of bronchiectasis involving
multiple lobes. High-resolution CT has a sensitivity and
specificity for bronchiectasis approaching that of
bronchography and, unlike bronchography, can be performed
safely and quickly on all patients.
Differential Diagnosis (DDx):
Cystic Fibrosis
Immotile Cilia Syndrome
References:
Neeld DA, Goodman LR, Gurney JW, Greenberger PA, Fink JN.
Computerized Tomography in the Evaluation of Allergic
Bronchopulmonary Aspergillosis. Am Rev Respir Dis 1990;
142:1200-1205.
Angus RM, Davies M-L, Cowan MD, McSharry C, Thomson NC.
Computed tomographic scanning of the lung in patients with
allergic bronchopulmonary aspergillosis and in asthmatic
patients with a positive skin test to Aspergillus fumigatus.
Thorax 1994; 49:586-589.
Case contributed by Oliver Ochs, MD and Debra Dyer,
MD.
Debra Dyer, MD (Deb.Dyer@UCHSC.edu)
