대한흉부영상의학회 Weekly Chest Cases

Case No : 1162 Date 2020-02-03

Courtesy of Hye Young Choi, Hye Jeon Hwang, Sang Young Oh, Kyung-Hyun Do / Asan Medical Center
Age/Sex 46 / F
Chief ComplaintChronic cough

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Diagnosis With Brief Discussion

Diagnosis: Allergic bronchopulmonary aspergillosis (ABPA)
Radiologic Findings: Fig 1-2. Chest radiograph shows tubular lesions in the central portions of left lower lung zone.
Fig 3-5. CT demonstrated multifocal bronchiectasis with growing endobronchial cystic lesion in the left lower lobe. The endobronchial lesion show high attenuation on pre-contrast image.
The patient had a history of asthma. She underwent segmentectomy and ABPA was diagnosed.
Brief Review: ABPA is a hypersensitivity reaction to Aspergillus antigens and is usually caused by Aspergillus fumigatus. ABPA is typically seen in patients with long-standing asthma or cystic fibrosis. It is believed that the Aspergillus-specific IgE-mediated type I hypersensitivity reaction and the specific IgG-mediated type III hypersensitivity reactions play an important role in the pathogenesis of ABPA.
Diagnostic criteria include the presence of asthma, peripheral blood eosinophilia, an immediate positive skin test for Aspergillus antigens, increased serum IgE levels, and pulmonary opacity on chest radiographs.
CT findings include mucoid impaction and bronchiectasis involving predominantly the segmental and subsegmental bronchi of the upper lobes, along with centrilobular nodules or branching linear structures. In approximately 30% of patients, the impacted mucus is highly opaque or demonstrates frank calcification at CT.
The differential diagnosis includes other causes of mucoid impaction such as endobronchial lesions, bronchial atresia, bronchiectasis, and bronchial asthma.
Please refer to: KSTR Imaging Conference 2005 Summer Case 5 ,
KSTR Imaging Conference 2008 Summer Case 2 ,
KSTR Imaging Conference 2016 Spring Case 4,
References: 1. Yeon Joo Jeong,, Kun-Il Kim et al. Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview. RadioGraphics 2007; 27:617
Keywords: airway, pulmonary aspergillosis, allergic bronchopulmonary aspergillosis, ABPA,

No. of Applicants : 73

▶ Correct Answer : 14/73, 19.2%

- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Niigata University , Japan ATSUSHI UEHARA
- Mayo Clinic , United States AKITOSHI INOUE
- National cancer center hospital east , Japan SHIOTO ODA
- , Jordan HISHAM IBRAHIM KHATIB
- Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
- , Japan NAOMI YUASA
- Ajou University Hospital , Korea (South) HYERIN KIM
- Seoul National University Hospital , Korea (South) SE WOO KIM
- Asan Medical Center , Korea (South) JIHOON KIM
- Okayama University Hospital , Japan SOICHIRO OKAMOTO
- Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- Ajou University Hospital , Korea (South) YONG HO JANG

▶ Correct Answer as Differential Diagnosis : 7/73, 9.6%

- CH de la Cote Basque , France PAUL ARDILOUZE
- Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
- Hamamatsu University Hospital , Japan HAYATO NOZAWA
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Hallym University Dongtan Medical Center , Korea (South) MINSU KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Holy Family Hopsital , India RAJESH GOTHI

▶ Semi-Correct Answer : 1/73, 1.4%

- University of Tsukuba Hospital , Japan SODAI HOSHIAI

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1162 Date 2020-02-03

Discussion

No. of Applicants : 73