CASE OF THE CASE OF THE MONTHMONTH

Dr. Vivek Patel, Dr. Dharmesh Dr. Vivek Patel, Dr. Dharmesh PatelPatel

X-ray chest X-ray chest

• An 80 yr. old man An 80 yr. old man refereed for HRCT refereed for HRCT chest for c/o chest for c/o chronic dry cough.chronic dry cough.

• Patient was a k/c/o Patient was a k/c/o br. Asthma and was br. Asthma and was using inhalation using inhalation pump. pump.

• X-ray showed some X-ray showed some vague opacities in vague opacities in the right upper and the right upper and left lower lobes. left lower lobes.

HRCT showing bilateral HRCT showing bilateral central bronchiectasis, with central bronchiectasis, with mucus impaction and faint mucus impaction and faint

tree in bud.tree in bud.

Coronal HRCT imagesCoronal HRCT images

Mediastinal windows Mediastinal windows showing hyperattenuating showing hyperattenuating

mucus impaction.mucus impaction.

A.B.P.A.A.B.P.A.

• A k/c/o allergic bronchial asthma.A k/c/o allergic bronchial asthma.• HRCT showing bilateral central HRCT showing bilateral central

bronchiectasis.bronchiectasis.• Hyperattenuated mucus impaction within Hyperattenuated mucus impaction within

the dilated bronchioles (density of the the dilated bronchioles (density of the impacted mucus with higher than the impacted mucus with higher than the chest wall muscles).chest wall muscles).

• All the above findings strongly favour a All the above findings strongly favour a possibility of allergic bronchopulmonary possibility of allergic bronchopulmonary aspergillosis.aspergillosis.

ABPAABPA

• A diagnosis of ABPA was suggested A diagnosis of ABPA was suggested on CT scan and patient’s IgE level on CT scan and patient’s IgE level and Eosinophil count were advised.and Eosinophil count were advised.

• Patient was found to have IgE level Patient was found to have IgE level of 12295 and Eosinophil of 32%.of 12295 and Eosinophil of 32%.

Take home messageTake home message

• Bilateral central bronchiectasis can Bilateral central bronchiectasis can have many d/ds. But when associated have many d/ds. But when associated with h/o allergic bronchial asthma and with h/o allergic bronchial asthma and hyperattenuated mucus impaction, hyperattenuated mucus impaction, almost serves as a hallmark for ABPA. almost serves as a hallmark for ABPA.

• Hyperattenuated mucus impaction in Hyperattenuated mucus impaction in the paranasal sinuses should also be the paranasal sinuses should also be investigated for allergic aspergillous investigated for allergic aspergillous sinusitis. sinusitis.