Presentation
Wheeze, cough and dyspnea for 5 months, worse at night and on exertion, relieved by inhaler.
Patient Data
Central varicose bronchiectasis in the right upper lobe, the medial segment of the middle lobe, the superior and posterior segments of the right lower lobe, the inferior lingular segment and the posterior and lateral segments of the left lower lobe. Hyperattenuating (+120HU) mucous plugging in the anterior and posterior segments of the right upper lobe and the superior and posterior segments of the right lower lobe and distal tree-in-bud opacities.
Case Discussion
Allergic bronchopulmonary aspergillosis (ABPA) is characterized by an exaggerated immune response to Aspergillus species in patients with asthma or cystic fibrosis. Our patient presented with symptoms consistent with asthma and her eosinophil count and serum IgE levels were elevated. The CT findings in conjunction with clinical and laboratory data were indicative of ABPA.
Mucous plugging which is hyperattenuating to skeletal muscle is thought to be pathognomonic of ABPA however this is an inconsistent finding.
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