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Allergic Bronchopulmonary Aspergillosis

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



Allergic Bronchopulmonary Aspergillosis (ABPA)

Caused by a hypersensitivity reaction; most commonly occurs in patients with asthma


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


  • 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).
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Thoracic Aspergillosis Imaging. A Khan. eMedicine

Allergic Bronchopulmonary Aspergillosis (ABPA). A Baptist and A Singer. University of Michigan. 1.21.0