Radiological manifestations of allergic bronchopulmonary aspergillosis in adult asthmatic patients

Allergic bronchopulmonary aspergillosis (ABPA) develops in patients through type I or type III hypersensitivity reactions to the filamentous fungi Aspergillus. There is a wide spectrum of radiological presentations of ABPA, including fleeting alveolar opacities, centrilobular nodules, bronchiectasis, mucoid impaction resulting in bronchocele, cavitation, and pulmonary fibrosis. This study aims to identify the pattern of radiological presentation in our community and its implications in the clinical diagnosis of the disease.

We conducted a descriptive, cross-sectional study. The study was conducted at the Department of Radiology, Combined Military Hospital, Bahawalpur, between 4th April 2021 and 3rd October 2021. A total of 85 asthmatic patients between the ages of 18 and 60 years with a clinical diagnosis of ABPA reporting for high-resolution computed tomography (HRCT) were included. Patients with bronchiectasis other than ABPA, such as tuberculosis, foreign body, recurrent aspiration, and malignancy, were excluded. All the patients underwent an HRCT scan of the chest.

In this study, the frequency of different radiological presentations of ABPA in adult asthmatic patients was as follows: mucus plug in 47 (55.29%) patients, centrilobular nodules in 49 (57.65%) patients, central bronchiectasis in 35 (41.18%) patients, and patchy air space consolidation in 37 (43.53%) patients.

This study concluded that centrilobular nodules are the most common radiological presentation of ABPA in adult asthmatic patients, followed by the mucus plug, patchy air space consolidation, and central bronchiectasis.