1. 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.

2. Case of the Month 22

3. Case of the Month 22

4. Case of the Month 22
What is your diagnosis ?

6. 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.

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

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

9. Case of the Month 22
What is your diagnosis ?

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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 Sep-Oct;28(5):
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 May-Jun;27(3):617-37; discussion
Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Franquet T, Müller NL, Giménez A, Guembe P, de La Torre J, Bagué S. Radiographics Jul-Aug;21(4):