Date: 26 November 2013
Recurrent pulmonary shadows 1. 6 Jan 1988 – chest radiograph showing right hilar enlargement, consistent with ABPA.
Recurrent pulmonary shadows 1. 3 Feb 1989 – chest radiograph showing right upper-lobe consolidation and contraction consistent with obstruction of RUL bronchus, in ABPA.
Clearing of pulmonary shadows 3, pt BJ. 5 April 1989 – resolution of shadows seen in February, with a course of corticosteroids.
Recurrence of pulmonary shadows 4, pt BJ. 2 September 1989 – recurrence of pulmonary shadows with an exacerbation of ABPA.
Central bronchiectasis, pt BJ. CT scan of thorax October 1989 showing central bronchiectasis, characteristic of ABPA (and cystic fibrosis).
Copyright: n/a
Notes:
The patient was later treated with itraconazole and reported in Denning DW, Van Wye J, Lewiston NJ, Stevens DA. Adjunctive therapy of allergic bronchopulmonary aspergillosis with itraconazole. Chest 1991; 100: 813-819.
Images library
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Image A
CT Scan 30/3/99
Showing extreme pleural thickening and 2 small cavities at apex of left lung.
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A 43 year old with smoking related emphysema was admitted to hospital with two separate episodes of haemoptysis. He had been in good health up to 1989, when he was diagnosed as having bilateral pulmonary tuberculosis. At that time a CT scan revealed a cavity in the left upper lobe (20.8cm2) with adjacent confluent infiltrates and pleural thickening. On bronchoscopic examination no abnormalities were noted and endobronchial biopsies did not reveal hyphae.
Over the next 4 years his condition deteriorated and a CT scan showed the left upper lobe cavity had increased to 40cm2. Itraconazole 400mg daily was prescribed. There was some clinical improvement on itraconazole but patient eventually deteriorated with breathlessness and with significant weight loss.
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