Allergic bronchopulmonary aspergillosis: the spectrum of computed tomography appearances

Abstract

Although computed tomography (CT) of the thorax has been compared to plain chest radiography and bronchography for demonstration of central bronchiectasis (CB) in allergic bronchopulmonary aspergillosis (ABPA), the CT presentation of the disease is yet to be highlighted. With this in view, the CT appearances in 23 patients with ABPA were evaluated. The scans were assessed for bronchial, parenchymal and pleural abnormalities. Central bronchiectasis was identified in all patients, involving 114 (85%) of the 134 lobes and 210 (52%) of the 406 segments studied. Other bronchial abnormalities such as dilated and totally occluded bronchi (11 patients), air-fluid levels within dilated bronchi (five patients), bronchial wall thickening (10 patients) and parallel-line shadows (seven patients) were also observed. Parenchymal abnormalities, which had a predilection for upper lobes, included consolidation in 10 (43%) patients, collapse in four (17%) patients and parenchymal scarring in 19 (83%) patients. A total of six cavities were seen in three (13%) patients, and an emphysematous bullae was detected in one (4%) patient. The pleura was involved in 10 (43%) patients. Ipsilateral pleural effusion with collapse was observed in one patient, while in nine other patients, parenchymal, lesions extended up to the pleura. Concomitant allergic Aspergillus sinusitis (AAS) was also detected in three (13%) of the 23 patients. Computed tomography of the thorax in patients with ABPA provides a sensitive method for the assessment of bronchial, parenchymal and pleural abnormalities, and should constitute a part of the diagnostic work of the disease.

Allergic Bronchopulmonary Aspergillosis (ABPA) misdiagnosed as Pulmonary Tuberculosis

“…These changes include normal chest radiography, nodules, avascular areas, various infiltrate patterns, consolidation, parallel lines and ring shadows, hyperinflation, band shadows and tramline shadows, "honey combing" "toothpaste" shadows, "gloved finger", changes like fibrosing alveolitis, lobar shrinkage and atelectasis as well as pseudohilar adenopathy and pleural thickening. [2][3][4][5][6][7][8] In the present case, the diagnosis of ABPA was established on clinical, hematological, immunological and radiological grounds. Two of the most common differential diagnoses of ABPA include bacterial pneumonia [9] and pulmonary tuberculosis [10,11] which should be given a great caution because of the high prevalence.…”

Allergic Bronchopulmonary Aspergillosis Presenting as Lobar or Total Lung Collapse

“…Parenchymal abnormalities, which have a predilection for upper lobes, include consolidation, collapse and parenchymal scarring. Parenchymal lesions can extend up to the pleura [24].…”

Pleural Effusion in a Patient With Allergic Bronchopulmonary Aspergillosis

“…4,5 The other reported pleural manifestation is secondary spontaneous pneumothorax. 6 -11 Pleural effusion is a rarely reported clinical presentation of ABPA.…”

“…A systematic search of the PubMed database, using the free text terms "ABPA" and "allergic bronchopulmonary aspergillosis," yielded 6 citations that have described the occurrence of pleural effusion in ABPA. 5,[12][13][14][15][16] Since the description of the first case of pleural effusion in a patient with ABPA in 1981, only 7 cases have been reported to date (Table). All the cases except one had unilateral effusion.…”

“…In 4 out of the 6 cases in which a diagnostic thoracentesis was performed, the cell population comprised predominantly lymphocytes or neutrophils. 5,[12][13][14] The other 2 cases manifested with eosinophilic pleural effusion, and of these one developed effusion during a relapse of ABPA. 15,16 The pleural fluid in one of the cases, along with eosinophilia, had empyematous characteristics, with a low pH, low glucose, and high eosinophil count.…”