Allergic bronchopulmonary aspergillosis: Lessons for the busy radiologist

Table 1 Diagnostic criteria for allergic bronchopulmonary aspergillosis[5]

Predisposing conditions

Bronchial asthma, cystic fibrosis, chronic obstructive lung disease

Obligatory criteria

Elevated total IgE levels (> 1000 IU/mL)

Elevated IgG and/or IgE against A. fumigatus

Other criteria (at least three of five)

Immediate cutaneous hypersensitivity to A. fumigatus antigen (type I reaction)

Presence of serum precipitins against A. fumigatus

Fixed/transient pulmonary opacities on chest radiograph

Peripheral blood eosinophil count > 1000 cells/μL

Bronchiectasis on HRCT chest

Please retain HRCT chest

A. fumigatus: Aspergillus fumigatus; HRCT: High-resolution computed tomography.

Table 2 Chest radiographic findings encountered in patients with allergic bronchopulmonary aspergillosis

Transient changes

Consolidation

Mucoid impaction - “finger-in-glove” and toothpaste shadows

Atelectasis

Bronchial wall thickening - tramline shadows

Nodular opacities

Rare: Pleural effusion, air-fluid levels due to fluid filled bronchiectatic cavities, perihilar bronchoceles simulating adenopathy, unilateral lung collapse, miliary nodules

Fixed changes

Bronchiectatic cavities

Rare: Pulmonary fibrosis and scars, pleural thickening, pneumothorax

Table 3 High-resolution computed tomography chest findings in allergic bronchopulmonary aspergillosis

Central bronchiectasis, extensive and involving more than three lobes

Mucus plugging, usually hypodense

High attenuation mucus, seen in up to 20% of patients

Centrilobular nodules with or without tree-in-bud opacities

Atelectasis, generally subsegmental or segmental

Areas of consolidation

Mosaic attenuation due to air trapping