Editorial
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Jul 28, 2011; 3(7): 178-181
Published online Jul 28, 2011. doi: 10.4329/wjr.v3.i7.178
Allergic bronchopulmonary aspergillosis: Lessons for the busy radiologist
Ritesh Agarwal
Ritesh Agarwal, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Agarwal R conceived, draft and revised the manuscript
Correspondence to: Dr. Ritesh Agarwal, MD, DM, Assistant Professor, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. riteshpgi@gmail.com
Telephone: +91-172-2756825 Fax: +91-172-2748215
Received: April 22, 2011
Revised: July 5, 2011
Accepted: July 12, 2011
Published online: July 28, 2011
Abstract

The probability of a radiologist interpreting a disease correctly is not only influenced by their training and experience but also on the knowledge of a particular entity. This editorial reviews certain myths and realities associated with radiological manifestations of allergic bronchopulmonary aspergillosis (ABPA). ABPA is a hypersensitivity disorder against the antigens of Aspergillus fumigatus. Although commonly manifesting with central bronchiectasis (CB), the disorder can present without any abnormalities on high-resolution computed tomography (HRCT) of the chest, so-called serologic ABPA (ABPA-S). HRCT of the chest should not be used in screening or in the initial diagnostic work up of asthmatics, as asthma without ABPA can manifest with findings of CB. High-attenuation mucus (HAM) is the pathognomonic sign of ABPA and is very helpful in the diagnosis of ABPA complicating asthma and cystic fibrosis. Instead of classifying ABPA based on the presence and absence of CB into ABPA-CB and ABPA-S respectively, ABPA should be classified as ABPA-S, ABPA-CB and ABPA-CB-HAM. The classification scheme based on HAM not only identifies an immunologically severe disease but also predicts a patient with increased risk of recurrent relapses.

Keywords: Allergic bronchopulmonary aspergillosis; Aspergillus; Asthma; Cystic fibrosis