67 years old female presenting with complaints of Chronic cough, One episode of hemoptysis
A. FINDINGS – HRCT CHEST
- AXIAL
- Diffuse central cystic and cylindrical bronchiectatic changes are noted in all lobes of both lungs (predominantly lower lobes). Multiple centrilobular 'tree in bud' nodules and ground glass nodules in the basal segments of both lower lobes.
- Multiple centrilobular 'tree in bud' nodules and ground glass nodules in the basal segments of both lower lobes. Associated peribronchial wall thickening with mucus plugging which are of high CT attenuation.
- Enlarged prevascular, pretracheal and paratracheal lymph nodes.
Allergic bronchopulmonary aspergillosis (ABPA) is the best-known allergic manifestation of Aspergillus-related hypersensitivity pulmonary disorders.
The clinical, radiological, and histological manifestations of bronchopulmonary aspergillosis depend not only on the number and virulence of the infective organism but also on the patient's immune response.
Depending on these factors, the disease can be classified as saprophytic, allergic, and invasive.
CHARACTERISTIC X-RAY APPEARANCES
CHARACTERISTIC CT APPEARANCES
Presentation of central bronchiectasis (arrow), with sparing of the periphery
Mucoid impaction with both hypo- (bold arrow) and hyper-dense (thin arrow) characteristics
Centrilobular nodules in a tree-in-bud pattern
MANAGEMENT
The primary aim of treatment in ABPA is to control acute inflammation, prevent recurrent exacerbations, and limit progressive lung injury, thereby preserving lung function.
Treatment of ABPA usually follows a stepwise approach:
- Systemic corticosteroids → control inflammation.
- Itraconazole or other antifungals → reduce fungal burden and steroid requirements.
- Regular IgE monitoring → detect response and relapse.
- Biologics (especially omalizumab) → for recurrent, refractory, or steroid-dependent disease.
- Airway clearance and asthma management → maintain long-term lung health.
REFERENCES
The spectrum of imaging findings in pulmonary aspergillosis
N. Bharwani et al
DOI-Link: https://dx.doi.org/10.1594/ECR06/C-182
Pictorial essay: Allergic bronchopulmonary aspergillosis
Ritesh Agarwal et al,
doi: 10.4103/0971-3026.90680
Allergic Bronchopulmonary Aspergillosis
Jitendrakumar Sisodia et al.
DOI: https://www.ncbi.nlm.nih.gov/books/NBK542329/
Dr. DEEPTI H V
Senior Consultant Radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru.
Dr. NIKITHA U N
Radiology resident
Manipal Hospital, Yeshwanthpur, Bengaluru.
