Case of the Month 22 April 2017 History:

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Case of the Month 22 April 2017 History: A 53-year-old female patient presented with cough since one month. She underwent surgery for a colon carcinoma one year earlier.

Case of the Month 22

Case of the Month 22

Case of the Month 22 What is your diagnosis ?

Case of the Month 22 April 2017 History: A 53-year-old female patient presented with cough since one month. She underwent surgery for a colon carcinoma one year earlier.

Case of the Month 22 Right upper lobe consolidation Hyperattenuating mucus plugging

Case of the Month 22 The patient underwent a bronchoscopy. No evidence of tumoral narrowing. Biopsies showed no tumoral cells. Culture: Aspergillus Fumigatus

Case of the Month 22 What is your diagnosis ?

ABPA: Allergic Broncho-Pulmonary Aspergillosis Case of the Month 22 ABPA: Allergic Broncho-Pulmonary Aspergillosis Precipitins were positive for Aspergillus fumigatus Author: D Tack, Baudour, Belgium

Discussion Case of the Month 22 ABPA: Colonization of the bronchial tree by A. fumigatus History of massive exposure ABPA is a diagnosis of exclusion

Discussion Case of the Month 22 CHEST RADIOGRAPHY Consolidation Bronchial pattern Finger-in-glove Sign HIGH-RESOLUTION CT Bronchial wall thickening Mucus plugging Hyperattenuating mucus plugging Consolidations

Case of the Month 22 Diagnosis Majors criteria Minors criteria Asthma Aspergillus fumiagtus in expectorations Eosinophilia (>500/ mm3) Delayed skin test + Total Ig E > 200 UI/ml Specific Ig E or specific Ig G against A. fumigatus Immediate skin tests + Proximal or central bronchiectasis Radiographic pulmonary infiltrates

Case of the Month 22 Treatment and evolution Repeated fibroscopies Medical treatment : Tazocin® et Sporanox® Control scan after two week of treatment – no atelectasis, no mass

Allergic Broncho-Pulmonary Aspergillosis Case of the Month 22 Further Reading Allergic Broncho-Pulmonary Aspergillosis Clinical and immunological criteriafor the diagnosis of ABPA. Rosenberg and Al.; Am J Int Med 1977; 86:405-14 Mucoid impactions: finger-in-glove sign and other CT and radiographic features. Martinez S, Heyneman LE, McAdams HP, Rossi SE, Restrepo CS, Eraso A. Radiographics. 2008 Sep-Oct;28(5):1369-82. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Jeong YJ, Kim KI, Seo IJ, Lee CH, Lee KN, Kim KN, Kim JS, Kwon WJ. Radiographics. 2007 May-Jun;27(3):617-37; discussion 637-9. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Franquet T, Müller NL, Giménez A, Guembe P, de La Torre J, Bagué S. Radiographics. 2001 Jul-Aug;21(4):825-37.