Allergic Bronchopulmonary Aspergillosis

allergic bronchopulmonary aspergillosis

Hypersensitivity towards Aspergillus spp. in patients with long standing asthma and occasionally cystic fibrosis. The hypersensitivity initially causes bronchospasm and bronchial wall oedema, which is IgE mediated. Ultimately there is bronchial wall damage, bronchiectasis and pulmonary fibrosis.

Radiological findings:
1. Fleeting pulmonary alveolar opacities (common)
2. Central, upper lobe saccular bronchiectasis (hallmark)
3. Mucus plugging (‘finger in glove appearance’) and bronchial wall thickening (common)
4. Chronic disease may progress to pulmonary fibrosis, predominantly in upper lobe (endstage)
5. Cavitation (10%)

Clinical findings:
1. Elevated Aspergillus specific IgE
2. Elevated precipitating IgG against Aspergillus
3. Peripheral eosinophilia
4. Positive skin test

Reference: Weissleder R et al. Primer of Diagnostic Imaging. 3rd ed. 1997

Credit: Dr Glenys Da Costa