Role of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis in adult patients with cystic fibrosis

Cortese, Giancarlo; Malfitana, V.; Placido, R.; Ferrari, A.; Grosso, B.; Rose, Virginia De; Néspoli, Pedro Eduardo Brandini; Fava, Cesare

doi:10.1007/s11547-007-0169-x

Cited by 10 publications

(3 citation statements)

References 19 publications

(45 reference statements)

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“…Cortese et al [25] confirmed the relative insensitivity of plain chest radiography as applied to diagnosing ABPA. Cortese et al [25] confirmed the relative insensitivity of plain chest radiography as applied to diagnosing ABPA.…”

Section: Chest Ct Imaging and Recognition Of Abpamentioning

confidence: 94%

Management of allergic aspergillosis

Moss

2008

Curr Fungal Infect Rep

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Treatment of allergic bronchopulmonary aspergillosis depends on accurate diagnosis, which is difficult because of multiple clinical, radiographic, and immunologic criteria; unstandardized immunoassays; and its similarity to cystic fibrosis. Advances in chest CT interpretation, measuring serum Aspergillus fumigatusspecific antibodies and the T H 2 chemokine thymusactivated-and-regulated chemokine, recognizing risk factors, should improve diagnostic accuracy. Oral glucocorticosteroids remain the mainstay of treatment. Dose regimen and duration are not standardized, so expert recommendations are used. Inhaled steroids have not been proven to be effective. Due to relapse and toxicity, itraconazole has been added as second-tier therapy, supported by randomized, placebo-controlled trials in asthma and open-label trials in cystic fibrosis. Itraconazole is steroid sparing with anti-inflammatory aspects and poor bioavailability. Despite combination steroid-itraconazole therapy, relapses and steroid toxicity have led to open-label use of voriconazole, nebulized amphotericin B, monthly high-dose intravenous methylprednisolone, and omalizumab. Controlled trials are needed to evaluate these and other antifungal or immunomodulatory interventions.

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Section: Chest Ct Imaging and Recognition Of Abpamentioning

confidence: 94%

Management of allergic aspergillosis

Moss

2008

Curr Fungal Infect Rep

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“…Expiratory CT identifies SAD and ideally should be controlled by spirometry [98,99] . SAD is recognised by the presence of hypodense areas within areas of mosaic attenuation and it is estimated that one third of hypodense regions persist over a 2 year period, which suggests irreversibility [12] . This may be used as a separate marker of pulmonary disease in conjunction with CT bronchiectasis scores.…”

Section: Dose Optimisation Protocolsmentioning

confidence: 99%

Computed tomography dose optimisation in cystic fibrosis: A review

Ferris

Twomey

Moloney

et al. 2016

WJR

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Cystic fibrosis (CF) is the most common autosomal recessive disease of the Caucasian population worldwide, with respiratory disease remaining the most relevant source of morbidity and mortality. Computed tomography (CT) is frequently used for monitoring disease complications and progression. Over the last fifteen years there has been a six-fold increase in the use of CT, which has lead to a growing concern in relation to cumulative radiation exposure. The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality, but fulfil the requirements of a diagnostic quality CT. Dose-optimisation, particularly in CT, is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 mSv, a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation. This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.

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“…Cortese et al [ 25 ] confi rmed the relative insensitivity of plain chest radiography as applied to diagnosing ABPA. In contrast, chest CT readily shows typical central (inner third of bronchial tree) segmental and subsegmental varicose or cystic bronchiectasis, mucoid impaction, and centrilobular nodules in small airways (ie, certain CT changes are sensitive but not specifi c for ABPA) [ 26 , 27 ].…”

Section: Chest Ct Imaging and Recognition Of Abpamentioning

confidence: 99%

Management of allergic aspergillosis

Moss

2008

Curr Allergy Asthma Rep

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Treatment of allergic bronchopulmonary aspergillosis depends on accurate diagnosis, which is diffi cult because of multiple clinical, radiographic, and immunologic criteria; unstandardized immunoassays; and its similarity to cystic fi brosis. Advances in chest CT interpretation, measuring serum Aspergillus fumigatusspecifi c antibodies and the T-helper type 2 chemokine thymus-activated-and-regulated chemokine, recognizing risk factors, should improve diagnostic accuracy. Oral glucocorticosteroids remain the mainstay of treatment. Dose regimen and duration are not standardized, so expert recommendations are used. Inhaled steroids have not been proven to be effective. Due to relapse and toxicity, itraconazole has been added as second-tier therapy, supported by randomized, placebo-controlled trials in asthma and open-label trials in cystic fi brosis. Itraconazole is steroid sparing with anti-infl ammatory aspects and poor bioavailability. Despite combination steroid-itraconazole therapy, relapses and steroid toxicity have led to open-label use of voriconazole, nebulized amphotericin B, monthly high-dose intravenous methylprednisolone, and omalizumab. Controlled trials are needed to evaluate these and other antifungal or immunomodulatory interventions.

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Role of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis in adult patients with cystic fibrosis

Abstract: Our results demonstrate the limited usefulness of chest radiography in the diagnosis of ABPA in patients with cystic fibrosis. The most significant abnormalities are nonspecific and commonly seen on baseline films in cystic fibrosis without ABPA and persist after treatment in most cases.

Cited by 10 publications

References 19 publications

Management of allergic aspergillosis

Management of allergic aspergillosis

Computed tomography dose optimisation in cystic fibrosis: A review

Management of allergic aspergillosis

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