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Case 35

Chronic allergic bronchopulmonary aspergillosis, with mycetoma

An asthmatic man who developed haemoptysis

This middle aged gentleman had suffered with asthma for many years, but had recently developed worsening symptoms associated with haemoptysis.

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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