Allergic Bronchopulmonary Aspergillosis: AllA Radiologist Needs To Know

Garg, Mandeep; Sharma, Madhurima; Agarwal, Ritesh; Aggarwal, Ashutosh N.; Gupta, Pankaj; Sodhi, Kushaljit Singh; Chakrabarty, Arunaloke; Khandelwal, Niranjan

doi:10.2174/1573396312666160831143951

Cited by 9 publications

(5 citation statements)

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“…Radiological findings in ABPA patients include migratory pulmonary infiltrates, central bronchiectasis, sub-segmental or segmental collapse, and centrilobular nodules. 11 In tuberculosis-endemic settings, misdiagnosis of ABPA as tuberculosis and vice versa is not uncommon. This is due to the overlapping symptoms and radiological findings of both conditions.…”

Section: Discussionmentioning

confidence: 99%

Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

Kumar¹,

Devi

Verma³

et al. 2023

IJIRM

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: Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic hypersensitivity reaction to the ubiquitous fungus Aspergillus that can cause inflammation and damage to the respiratory system. This condition predominantly occurs in individuals with long-standing airway disease, such as bronchial asthma or cystic fibrosis. While Acid-fast bacilli Mycobacterium tuberculosis causes tuberculosis (TB). ABPA and TB can coexist in the same patient. The coexistence of these two conditions can make the diagnosis and treatment more challenging. This is because some of the symptoms of ABPA, such as cough and wheezing, can be similar to those of TB, and both conditions can cause lung damage. A 21-year young male was admitted with a six-month history of low-grade fever, cough with expectoration, atypical chest pain, and progressive breathlessness. On examination, the patient had bilateral diffuse rhonchi with coarse crepitation, and his chest X-ray showed bilateral heterogeneous opacities with cavities in the left upper and middle zone. Further evaluation revealed a total serum IgE of 3074 IU/L (Normal <100) and elevated levels of Aspergillus fumigatus-specific IgE and IgG. A high-resolution CT of the thorax revealed bilateral upper lobes with tree-in-bud opacities and centrilobular nodules, leading to a diagnosis of ABPA. A sputum sample was sent for an AFB smear, which was positive.Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus that most commonly affects people who have bronchial asthma or cystic fibrosis. However, diagnosis can be challenging as patients may not respond to standard treatment, and the symptoms can overlap with those of other respiratory diseases. Therefore, clinicians need to maintain a high index of suspicion for ABPA in at-risk patients and consider appropriate screening tests.This case highlights the rare co-existence of active pulmonary TB and ABPA, which can make diagnosis and treatment challenging. However, with appropriate management, including anti-tubercular treatment and corticosteroid therapy, the patient showed marked improvement in his condition. Clinicians should consider the possibility of multiple comorbidities in patients presenting with respiratory symptoms, and appropriate evaluation and management should be undertaken to achieve optimal outcomes.

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Section: Discussionmentioning

confidence: 99%

Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

Kumar¹,

Devi

Verma³

et al. 2023

IJIRM

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“…Mucoid impaction may obstruct the lobar bronchi, leading to the finger-in-glove sign with lobar atelectasis seen on chest radiography. Lobar or segmental lung collapses have been described in 14–39% of patients with ABPA [ 6 – 8 ]. Our study showed that total lung collapse could also be a manifestation of ABPA although it is less frequently reported in the literature [ 9 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this context, the diagnosis of ABPA may be supported by the presence of typical radiologic findings. The most common CT-scan findings are mucoid impactions and bronchiectasis predominantly involving the segmental and subsegmental bronchi of the upper lobes, with centrilobular nodules [ 6 – 8 ]. In case of total unilateral lung collapse, these imaging findings should be investigated in the contralateral lung.…”

Section: Discussionmentioning

confidence: 99%

“…It is the most common Aspergillus -related disorder and usually affects patients with a preexisting respiratory disorder such as asthma or cystic fibrosis [ 3 – 5 ]. The radiographic findings associated with ABPA usually include proximal or distal mucoid impaction, pulmonary infiltrates or condensations, and centrolobular nodules [ 6 – 8 ]. Mucus plugs can lead to segmental or lobar atelectasis, and are more often described in the literature [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The radiographic findings associated with ABPA usually include proximal or distal mucoid impaction, pulmonary infiltrates or condensations, and centrolobular nodules [ 6 – 8 ]. Mucus plugs can lead to segmental or lobar atelectasis, and are more often described in the literature [ 6 – 8 ]. However, complete lung atelectasis due to ABPA is extremely rare with only a few cases reported in the literature [ 9 – 16 ], so that specific therapeutic guidelines are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Total unilateral pulmonary collapse secondary to allergic bronchopulmonary aspergillosis: a case series of an unusual cause of complete atelectasis

et al. 2021

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Background Allergic bronchopulmonary aspergillosis (ABPA) is a bronchopulmonary disease caused by a complex hypersensitivity to Aspergillus and is usually associated with underlying respiratory diseases such as asthma or cystic fibrosis. Mucus plugging can lead to segmental or lobar atelectasis, but complete lung atelectasis has been exceptionally reported in the literature, making it difficult to diagnose. The diagnosis of ABPA may however be suggested in patients without known predisposing respiratory disorder, even in the absence of other relevant radiographic findings. Case presentation We report five cases of total unilateral lung collapse secondary to ABPA in 70–81-year-old women. Two of them had a past history of ABPA, while total unilateral lung collapse was the first sign of the disease in the other three patients, contributing to the initial misdiagnosis. Flexible bronchoscopy was initially performed to remove mucus plugs from the obstructed airways but was inefficient in four cases. Corticosteroid and/or antifungal treatment was needed. Conclusion ABPA can cause total unilateral lung collapse even in patients without known underlying chronic respiratory disease, making the diagnosis difficult. Flexible bronchoscopy should be considered when lung collapse is associated with respiratory distress but corticosteroids are the mainstay treatment for ABPA.

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Lungenerkrankungen jenseits des Neugeborenenalters

Hahn

Renz

2019

Bildgebung Des Thorax Bei Neugeborenen Und Kleinkindern

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Allergic Bronchopulmonary Aspergillosis: AllA Radiologist Needs To Know

Abstract: In recent years, role of radiology in ABPA has evolved. Radiology plays an important role not only in diagnosis but also classification and prognostication of the disease. A radiologist should also be familiar with the clinical spectrum and laboratory findings of the disease.

Cited by 9 publications

References 0 publications

Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

Total unilateral pulmonary collapse secondary to allergic bronchopulmonary aspergillosis: a case series of an unusual cause of complete atelectasis

Lungenerkrankungen jenseits des Neugeborenenalters

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