CTICasesAllergic Bronchopulmonary Aspergillosis
Imaging findings
Serial chest CT scans in a 54-year-old female show progressive, bilateral upper lobe consolidative opacities. High-resolution CT shows central bronchiectasis with high-attenuation mucus impaction (hyperdense mucus casts) in the right upper and right lower lobes. Bronchoscopy reveals eosinophilic inflammation and grows Aspergillus fumigatus, with dramatic resolution after initiating high-dose steroids.
Key takeaways
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus species colonizing the airways, classically seen in asthmatics. The hallmark imaging clue is central bronchiectasis containing high-attenuation mucus plugs, which appear hyperdense on CT due to the deposition of calcium and heavy metals (iron and manganese) by the fungus. Treatment requires corticosteroids and often oral antifungals.
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