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Objective To investigate the high-resolution CT (HRCT) imaging characteristics of allergic bronchopulmonary aspergillosis (ABPA) to improve the diagnostic accuracy.Methods The clinical data of 21 patients with ABPA diagnosed in Dalian Second People's Hospital and Nanjing Lishui District Hospital of Traditional Chinese Medicine from January 2010 to June 2018 were retrospectively analyzed,and their clinical manifestations and HRCT examinations were statistically analyzed to summarize the HRCT imaging manifestations.Results Among the 21 patients,cough,expectoration and wheezing were the main clinical symptoms,followed by fever and hemoptysis;5 patients had a history of drug or food allergy.ABPA showed 18 cases of central bronchiectasis on HRCT,including 10 cases of simple bronchiectasis,9 cases with low-attenuation mucus,and 6 cases with high-attenuation mucus;patchy consolidation infiltration were seen in 11 cases;masses were seen in 2 cases;central nodules and tree buds were seen in 3 cases;mediastinal lymph nodes were enlarged in 6 cases.Conclusions HRCT imaging of ABPA is difficult to diagnose,and central bronchiectasis with high-attenuation mucus is characteristic.It can be used as a reliable basis for the diagnosis of ABPA imaging.Combined with clinical and laboratory examinations,it can generally be diagnosed clearly.
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BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves. OBJECTIVE: To highlight the presentation of ABPA in children with asthma. METHODS: This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS. RESULTS: Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis. CONCLUSION: This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.