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CASE OF THE MONTH. Dr. Vivek Patel, Dr. Dharmesh Patel. X-ray chest. 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. X-ray showed some vague opacities in the right upper and left lower lobes.

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case of the month

CASE OF THE MONTH

Dr. Vivek Patel, Dr. Dharmesh Patel

x ray chest
X-ray chest
  • 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.
  • X-ray showed some vague opacities in the right upper and left lower lobes.
a b p a
A.B.P.A.
  • A k/c/o allergic bronchial asthma.
  • HRCT showing bilateral central bronchiectasis.
  • 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.
slide7
ABPA
  • 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%.
take home message
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.
  • Hyperattenuated mucus impaction in the paranasal sinuses should also be investigated for allergic aspergillous sinusitis.