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Weekly Chest CasesArchive of Old Cases

Case No : 1281 Date 2022-05-09

  • Courtesy of Jong Eun Lee, Won Gi Jeong, Yun-Hyeon Kim / Chonnam National University Hospital, Chonnam National University Hwasun Hospital
  • Age/Sex 38 / M
  • Chief ComplaintChronic cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Allergic bronchopulmonary aspergillosis (ABPA)
Radiologic Findings
Figs 1-2. Axial lung-window CT images reveal multifocal bronchial mucus plugging, bronchial wall thickening, and poorly-defined centrilobular nodules in bilateral lung fields.
Figs 3-4. Axial mediastinal-window CT images obtained at the same level reveal that some of the bronchial mucus pluggings contain high attenuation.

The patient underwent bronchoscopy and thick materials-filled bronchi were found. Results of the histopathologic analysis revealed findings of allergic mucin and aspergillus, which are consistent with allergic bronchopulmonary aspergillosis (ABPA).
 
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.

References
1. Yeon Joo Jeong,, Kun-Il Kim et al. Eosinophilic Lung Diseases: A Clinical, Radiologic, and Pathologic Overview. RadioGraphics 2007; 27:617– 639.
2. Toma´ s Franquet, Nestor L. Mu¨ller et al. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings. RadioGraphics 2001; 21:825–837.
3. Ritesh Agarwal, Ajmal Khan et al. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol 2012 April 28; 4(4): 141-150.
Please refer to
Case 122 Case 158 Case 665 Case 944 Case 1162
Keywords
Allergic Bronchopulmonary Aspergillosis (ABPA),

No. of Applicants : 113

▶ Correct Answer : 78/113,  69.0%
  • - Wakayama Red Cross Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , United Kingdom SAMSON KADE
  • - Chonnam National University Hwasun Hospital , Korea (South) SEONGWOO CHO
  • - CHCB , France LE GUEN RAPHAEL
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Chungbuk National University Hospital , Korea (South) HOSIG JANG
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - , Korea (South) SUNHYANG LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chungbuk National University Hospital , Korea (South) JUNGHYUN LEE
  • - , Korea (South) YEONG UK HWANG
  • - Other , Korea (South) MARI A
  • - , France LOIC BOISLIVEAU
  • - , United States HIROAKI TAKAHASHI
  • - , Japan SHUNJIRO NOGUCHI
  • - , Japan MIDORI UENO
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Seoul Medical Center , Korea (South) YONGJOO LEE
  • - GHICL , France MANUEL TOLEDANO
  • - Other , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Pusan National University Yangsan Hospital , Korea (South) WOOKON SON
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - , Korea (South) SEUNG HOON OH
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Chungbuk National University Hospital , Korea (South) HYE SOO CHO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Hanyang University Hospital , Korea (South) SUNJIN RYU
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chonnam National University Hospital , Korea (South) EUN JU KIM
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 4/113,  3.5%
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Japan CHIAKI SATO
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Seoul National University Bundang Hospital , Korea (South) SUNYOUNG PARK
▶ Semi-Correct Answer : 5/113,  4.4%
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , United Arab Emirates NEHAR RANJAN CHAKRABORTY
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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