Allergic Bronchopulmonary Aspergillosis (ABPA)

Clinical Information:

This 35 year old female has had asthma since age 3. Exacerbations of her asthma were frequent and characterized by sudden onset of malaise, pleuritic chest pain, cough, and wheezing. She was diagnosed with ABPA at age 23 after a work-up identified increased serum IgE, increased serum eosinophils, positive skin test to Aspergillus, and proximal bronchiectasis.

Imaging:

The CXR shows bronchial wall thickening and impressive central bronchiectasis.

The CT demonstrates varicoid and cystic central bronchiectasis in all 5 lobes and mucous plugging.

Discussion:

ABPA was first described by Hinson in the United Kingdom in 1952. Diagnostic criteria for ABPA include the presence of asthma,a history of pulmonary infiltrates, peripheral blood eosinophilia, immediate-type skin reactivity, serum precipitating antibodies toAspergillus-specific IgE and IgG and central (proximal) bronchiectasis. The disease is being recognized more frequentlydue to increased physician awareness and better diagnostic techniques.

Bronchiectasis alone may be present in patients with asthma not complicated by ABPA but it is uncommon for asthmatics withoutABPA to have severe forms of bronchiectasis involving multiple lobes. High-resolution CT has a sensitivity and specificity for bronchiectasis approaching that of bronchography and, unlike bronchography, can be performed safely and quickly on all patients.

Differential Diagnosis (DDx):

Cystic Fibrosis

Immotile Cilia Syndrome

References:

Neeld DA, Goodman LR, Gurney JW, Greenberger PA, Fink JN. Computerized Tomography in the Evaluation of Allergic Bronchopulmonary Aspergillosis. Am Rev Respir Dis 1990; 142:1200-1205.

Angus RM, Davies M-L, Cowan MD, McSharry C, Thomson NC. Computed tomographic scanning of the lung in patients with allergic bronchopulmonary aspergillosis and in asthmatic patients with a positive skin test to Aspergillus fumigatus. Thorax 1994; 49:586-589.

Case contributed by Oliver Ochs, MD and Debra Dyer, MD.


Debra Dyer, MD