(Allergic BronchoPulmonary Aspergillosis)
Chest radiograph shows an ovoid increased density in right perihilar region.
CT scans show a well-defined, ovoid, lobulating mass showing branching structures, which manifests persistent low-attenuation on contrast-enhanced CT scans.
On expiratory, delayed thin-section CT scan,
Pulmonary disorders associated with hypersensitivity to fungus include
On thin-section CT,
Among major criteria for diagnosis of ABPA including
only proximal bronchiectasis is considered specific.
In one study (3), cylindrical bronchiectasis was the only type found in the non-ABPA asthmatics, whereas more
severe bronchiectatic changes were detected in patient with ABPA and the finding of bronchiectasis was thought to
represent advanced disease which mandate aggressive corticosteroid therapy.
1. Fraser RG, Pare JAP, Pare PD, Fraser RS, Genereux GP. Infectious disease of the lungs. In: Fraser RG, ed. Diagnosis
of Disease of the chest. 3rd ed. Philadelphia, Pa: Saunders, 1989;996-1007
The following comments of Dr. Ivan Pilate from Belgium contain many important differential diagnoses,
which also should be considered in this case.
Dear Dr. Kim,
About case 158:
Branching opacities without contrast enhancement, with air-trapping in a young, asthmatic patient.
Asthmatic patients can have ectatic bronchi.
I think this is a case of mucoid impaction in an ectatic bronchus, with or without ABPA.
Less likely is a mycetoma in an ectatic bronchus (filling the whole cavity).
We have to exclude underlying diseases:
1. Congenital abnormalities: - especially bronchial atresia;
- lung sequestration is another possibility, but less likely in this location.
2. Obstruction from tumor : - endobronchial tumors like carcinoid, hamartoma or lipoma ;
- adenoid cystic carcinoma and mucoepidermoid carcinoma : both can be slow-growing (with development of mucus plugs) and can simulate asthma.
3. Obstruction from foreign body.
I thank you,
Dr. Ivan Pilate
Stedelijk OLV-Ziekenhuis Mechelen, Belgium
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