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Weekly Chest CasesArchive of Old Cases

Case No : 944 Date 2015-11-30

  • Courtesy of Kyung Hee Lee, Kyung Won Lee / Seoul National University Bundang Hospital
  • Age/Sex 44 / F
  • Chief ComplaintSputum (4 months ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Allergic Bronchopulmonary Aspergillosis (ABPA)
Radiologic Findings
Chest PA radiograph shows multifocal tubular opacities with finger-in-glove appearance in both middle lung zones.
Chest CT images show multifocal central bronchiectasis and multiple endobronchial filling masses in the BUL and RML.
The corresponding endobronchial mass lesions show high attenuation on precontrast image.
The laboratory finding showed elevated serum IgE level. The patient underwent bronchoscopic biopsy at the right middle lobe and pathology revealed eosinophilic abscess, thick mucus and some degenerated fungal hyphae, morphologically consistent with aspergillosis.
Brief Review
High-attenuation mucous plugs are characteristic imaging finding of allergic bronchopulmonary aspergillosis. It is reported to occur in up to 30% of patients with ABPA. High-density mucus presumably represents the presence of calcium ions, metallic ions, or both, within viscous mucus, concentrated by the fungal organisms. It has been reported that the presence of high-density mucus in patients with ABPA correlates with disease severity. The patients with central bronchiectasis with high-attenuation mucus have higher levels of inflammation and frequent relapse following therapy.
Please refer to
Case 122, Case 158, Case 665,
KSTR Imaging Conference 2008 Summer  Case 2 ,
KSTR Imaging Conference 2008 Spring  Case 10,
References
W. Richard Webb, Nestor L. Muller, David P. Naidich, High-resolution CT of the Lung, Fifth edition, 584-586.
Keywords
Lung, Airway, Eosinophilic lung disease, Fungal infection,

No. of Applicants : 101

▶ Correct Answer : 69/101,  68.3%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Himeji Redcross Hospital , Japan Soichiro Okamoto
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Universidad de Chile , Chile Gonzalo Pereira
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - �stanbul , Turkey Ayhan Yilmaz
  • - University of British Columbia , Canada Amr Ajlan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - university of montreal , Canada Andrei Gorgos I
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - ROKAF 10th Fighter Wing , Korea (South) Kun Woo Kang
  • - stanley medical college , India yazhini v
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - 異⑸ , Korea (South) Yunhee Jang
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - GHICL , France manuel toledano
  • - MUHC , Canada Hani AlSalam
  • - Kyoto University , Japan Akihiko Sakata
  • - coimbatore medical college hospital , India keerthivasan sivanmani
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
  • - CLCC Rennes , France nicolas gautier
  • - Intermed Hospital , Mongolia Khulan Khurelsukh
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Asan medical center , Korea (South) Cherry Kim
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - , Korea (South)
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - , Korea (South) BAEK YOOLIM
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - okayama university , Japan numa shingo
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - RAGGI X MODUGNO , Italy eleonora tricarico
  • - CHU Poitiers , France CHAN paul
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - NASA SCANS , India RAKESH BHATIA
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - Wuhan Union Hospital , China Qiguang Cheng
  • - Hopital du Sacre Coeur , Canada Andrea Ojanguren
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - PNUH , Korea (South) Seungbaek Hong
  • - Busan national univercity hospital radiology department , Korea (South) Il-wan Son
  • - pusan national university hospital , Korea (South) kim jeongmyeong
▶ Correct Answer as Differential Diagnosis : 5/101,  5.0%
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
▶ Semi-Correct Answer : 6/101,  5.9%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - CHRU Lille , France Paul Lebert
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - IRSA La Rochelle , France Denis Chabassiere
  • - chp st martin , France Mariotte benoit
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