CTICasesAllergic Bronchopulmonary Aspergillosis (ABPA) and Inflammatory Bowel Disease-Associated Large Airway Disease
Imaging findings
Chest CT shows a substantial amount of thick intraluminal mucus impaction within the segmental and subsegmental bronchi, accompanied by central bronchiectasis and bronchial wall thickening, most prominent in the right middle and lower lobes. Additionally, there is profound, diffuse thickening of the trachea and main bronchi, particularly involving the posterior membranous wall, and mosaic perfusion with air trapping.
Key takeaways
Patients with inflammatory bowel disease (IBD) can develop severe, diffuse tracheobronchitis characterized by circumferential tracheal and bronchial wall thickening, which can predispose them to colonization and hypersensitivity reactions such as Allergic Bronchopulmonary Aspergillosis (ABPA). ABPA is diagnosed based on clinical and laboratory criteria (asthma history, elevated IgE, Aspergillus antibodies, and peripheral eosinophilia) and typically shows central bronchiectasis and "finger-in-glove" mucus impaction on imaging.
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