1. CASE OF THE MONTH Dr. Vivek Patel, Dr. Dharmesh Patel

2. X-ray chest An 80 yr. old man refereed for HRCT chest for c/o chronic dry cough.An 80 yr. old man refereed for HRCT chest for c/o chronic dry cough. Patient was a k/c/o br. Asthma and was using inhalation pump.Patient was a k/c/o br. Asthma and was using inhalation pump. X-ray showed some vague opacities in the right upper and left lower lobes.X-ray showed some vague opacities in the right upper and left lower lobes.

3. HRCT showing bilateral central bronchiectasis, with mucus impaction and faint tree in bud.

4. Coronal HRCT images

5. Mediastinal windows showing hyperattenuating mucus impaction.

6. A.B.P.A. A k/c/o allergic bronchial asthma.A k/c/o allergic bronchial asthma. HRCT showing bilateral central bronchiectasis.HRCT showing bilateral central bronchiectasis. Hyperattenuated mucus impaction within the dilated bronchioles (density of the impacted mucus with higher than the chest wall muscles).Hyperattenuated mucus impaction within the dilated bronchioles (density of the impacted mucus with higher than the chest wall muscles). All the above findings strongly favour a possibility of allergic bronchopulmonary aspergillosis.All the above findings strongly favour a possibility of allergic bronchopulmonary aspergillosis.

7. ABPA A diagnosis of ABPA was suggested on CT scan and patient’s IgE level and Eosinophil count were advised.A diagnosis of ABPA was suggested on CT scan and patient’s IgE level and Eosinophil count were advised. Patient was found to have IgE level of 12295 and Eosinophil of 32%.Patient was found to have IgE level of 12295 and Eosinophil of 32%.

8. Take home message Bilateral central bronchiectasis can have many d/ds. But when associated with h/o allergic bronchial asthma and hyperattenuated mucus impaction, almost serves as a hallmark for ABPA.Bilateral central bronchiectasis can have many d/ds. But when associated with h/o allergic bronchial asthma and hyperattenuated mucus impaction, almost serves as a hallmark for ABPA. Hyperattenuated mucus impaction in the paranasal sinuses should also be investigated for allergic aspergillous sinusitis.Hyperattenuated mucus impaction in the paranasal sinuses should also be investigated for allergic aspergillous sinusitis.