CTICasesLocalized (Unilobar) Allergic Bronchopulmonary Aspergillosis
Imaging findings
A patient with a history of childhood asthma and new productive cough with brown sputum had a radiograph with an abnormal opacity over the aortic arch region, and CT showed disease confined entirely to the right upper lobe with tree-in-bud nodules, branching mucus-filled airways, and high-attenuation mucus on soft-tissue windows, without bronchiectasis or mucous impaction elsewhere in the lungs. Bronchoscopy retrieved brown mucus plugs with Aspergillus, confirming allergic bronchopulmonary aspergillosis localized to a single lobe, which improved substantially with steroids and bronchial clearance, leaving only mild residual focal bronchiectasis.
Key takeaways
Allergic bronchopulmonary aspergillosis can occasionally present as a unilateral, single-lobe process (most often the right upper lobe) rather than diffusely, and high-attenuation mucus on soft-tissue windows remains a fairly specific, if underrecognized, clue to the diagnosis even when disease is localized; a history of asthma with new brown-tinged sputum should prompt evaluation for ABPA even when imaging findings are confined to one lobe.
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