CTICasesAllergic Bronchopulmonary Aspergillosis
Imaging findings
High-resolution CT demonstrates moderate tree-in-bud nodularity, bronchial wall thickening, and multifocal small-airways nodules. Scattered mucous plugging is present within the medium and small airways, along with localized bands of subsegmental atelectasis, patchy ground-glass attenuation, and lobular areas of air trapping.
Key takeaways
Allergic bronchopulmonary aspergillosis (ABPA) typically occurs in patients with a history of asthma or cystic fibrosis and can present as an atypical small airways-predominant bronchiolitis rather than classic central bronchiectasis with finger-in-glove mucous plugging. The diagnosis should be considered in asthmatic patients presenting with chronic, treatment-resistant airway symptoms, eosinophilia, and elevated serum IgE levels. Atypical or widespread tree-in-bud patterns of ABPA can mimic non-tuberculous mycobacterial (NTM) infections, necessitating serologic and microbiological workup to guide appropriate steroid and antifungal therapy.
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