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Allergic Bronchopulmonary Aspergillosis
ABPA
General Considerations
- Inflammation of the airways caused by an allergic response to Aspergillus Fumigatus, frequently
- Associated in 2% of cases with asthma and in 10% of cases of cystic fibrosis
- Most common in 3rd-4th decades of life
- Repeated episodes of inflammation and obstruction lead to bronchiectasi
Types of Pulmonary Aspergillosis |
Type |
Remarks |
Allergic Bronchopulmonary Aspergillosis (ABPA) |
Caused by a hypersensitivity reaction; most commonly occurs in patients with asthma |
Aspergilloma |
Most common form; noninvasive; involves formation in preexisting cavities |
Chronic necrotizing aspergillosis (AKA airway-invasive or semi-invasive aspergillosis); saprophytic aspergillosis |
Chronic, cavitary, pneumonic illness; often affects patients with preexisting chronic lung disease |
Angioinvasive aspergillosis |
Serious, often fatal disease, that affects immunocompromised patients |
Clinical Findings
- Symptoms of asthma (frequently present for years)
- Fever
- Expectoration of brownish mucous plugs
- Diagnostic criteria
- Asthma
- Elevated serum IgE
- Central bronchiectasis
- Infiltrates on chest x-ray
- Peripheral eosinophilia
- Elevated antibodies to Aspergillus Fumigatus
Imaging Findings
- CT is the study of choice
- Migratory fleeting pulmonary opacities
- Bronchial wall thickening
- Central bronchiectasis, especially in 3 or more lobes in an asthmatic
- Mucoid impaction, which may be of higher attenuation than soft tissue in 30%
- Mucoid impaction may occur without ABPA
- Most often in upper lobes
- Tubular branching pattern of mucoid impaction produces a "finger-in-glove" appearance
- Mostly involves segmental and subsegmental bronchi
- Most have peripheral tree-in-bud abnormalities
- No pleural effusion and almost never adenopathy
Differential Diagnosis
- Cystic Fibrosis
- Congenital Bronchial Atresia
Treatment
- Oral corticosteroids are the treatment of choice
- Antifungal agents
- Response to therapy may be monitored by serial serum IgE measurements
Allergic Bronchopulmonary Aspergillosis (ABPA). In both the upper radiograph and lower close-up of the right upper lobe, there are several dense, tube-like soft tissues that extend from the hilum of the right lung outward in a "glove-in-finger" appearance consistent with ABPA (white arrows).
For these same photos without the arrows, click here and here
For more information, click on the link if you see this icon 
Thoracic Aspergillosis Imaging. A Khan. eMedicine
Allergic Bronchopulmonary Aspergillosis (ABPA). A Baptist and A Singer. University of Michigan. 1.21.0
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