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ALL / Respiratory Medicine

Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia.

Features
  • bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
  • bronchiectasis (proximal)

Investigations
  • eosinophilia
  • flitting CXR changes
  • positive radioallergosorbent (RAST) test to Aspergillus
  • positive IgG precipitins (not as positive as in aspergilloma)
  • raised IgE

Management
  • oral glucocorticoids
  • itraconazole is sometimes introduced as a second-line agent

Chest x-ray of a 40-year-old woman with ABPA demonstrating a mass overlying the left hilum. In the right upper parahilar region a few ring shadow / tram track opacities are also noted, suggestive of bronchiectasis
CT scan from the same patient. CT reveals a branching lesion in the superior segment of the left lower lobe with classic finger in glove appearance which represents of mucous filling dilated bronchi (i.e. bronchocoeles). Bronchocoeles are a common feature of allergic bronchopulmonary aspergillosis (ABPA)
+PassMedicine Notes

Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia.

Features
  • bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
  • bronchiectasis (proximal)
Investigations
  • eosinophilia
  • flitting CXR changes
  • positive radioallergosorbent (RAST) test to Aspergillus
  • positive IgG precipitins (not as positive as in aspergilloma)
  • raised IgE
Management
  • oral glucocorticoids
  • itraconazole is sometimes introduced as a second-line agent


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