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Case 35

Chronic allergic bronchopulmonary aspergillosis, with mycetoma

Findings

There are bilateral perihilar areas of shadowing with bronchial wall thickening and dilatation, indicating central bronchiectasis. In addition there is a large thick walled cavity in the periphery of the left mid zone, which also contains an irregular soft tissue density. This appearance is typical of a mycetoma in a cavity.

Diagnosis

Chronic allergic bronchopulmonary aspergillosis, with mycetoma

Discussion

Chronic allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction towards Aspergillus fumigatus, an upper respiratory tract commensal. It occurs most frequently in asthmatics, and is often associated with a blood eosinophilia.

It causes central bronchiectasis and may lead on to fibrosis, particularily of the upper lobes.

Cavitation and mycetoma formation are however unusual in ABPA. Mycetomas are a non invasive form of aspergillosis that tend to occur in pre existing cavities, for instance in the upper lobes following tuberculosis.

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