Presentation
Chronic cough
Patient Data
Multiple moderate patchy areas of cylindrical bronchiectasis in the bilateral lung, predominantly in the central location. Few of them are filled with high attenuation mucus plug (HAM) and hypodense secretion/mucus.
Few small patchy areas of tree in bud nodules are scattered in the bilateral upper lobes.
Few linear fibro atelectasis bands are seen in the lateral basal segment of right lower lobe.
Follow up CT after six months of treatment shows:-
patchy areas of moderate cylindrical bronchiectasis changes in the bilateral lung in central location
patchy areas of mosaic attenuation in the bilateral lung, likely due to air trapping
few linear fibro atelectasis bands in the right lower lobe
diffuse mild increase in attenuation of the bilateral lung, likely due to expiratory view
In comparison to the previous CT, there is complete resolution of high attenuation mucus plug, mucus/secretion and tree in bud nodules with residual bronchiectasis changes.
Case Discussion
Initial imaging findings are suggestive of allergic bronchopulmonary aspergillosis (ABPA).
The other investigations are as follows:-
mild increase in total leukocyte count with eosinophil count is ~6.6%
total IgE level is ~1000 KIU/L (Ref. range: <150 KIU/L)
allergy marker-aspergillus fumigatus ~9.58 kUA/l (Ref. range: 0.1)
aspergillus antibody (IgG) ~5.94 (Ref. range <0.80)
The overall findings confirm the diagnosis of allergic bronchopulmonary aspergillosis (ABPA).
The patient was treated with antifungal agent and steroid. After six months of treatment, there is significant improvement of patient symptoms and complete resolution of high attenuation mucus plug, secretion/mucus and tree in bud nodules.
Co-author: Dr. Vijay Kumar, Pulmonologist.
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