Mucoid impaction due to ABPA – Pt DL.

Date: 26 November 2013

  • Image A. Her chest x-ray (Oct 04) shows consolidation of her left lower lobe with slight mediastinal shift, but some diaphragmatic elevation.

  • Image B. Progression of the process was documented in Dec (04) by chest x-ray, and bronchoscopy had not identified a malignant lesion.

  • Image C. CT scan of the chest (Oct 04) shows extensive collapse of the left lung with only slight aeration of the left upper lobe. No definite central mass can be identified and no lymphadenopathy was visible. There is a small left sided pleural effusion. The right lung is normal. “The overall appearances remain highly suspicious of a central broncho-occlusive lesion on the left side.

  • Image D. CT scan of the chest (Oct 04) shows extensive collapse of the left lung with only slight aeration of the left upper lobe. No definite central mass can be identified and no lymphadenopathy was visible. There is a small left sided pleural effusion. The right lung is normal. “The overall appearances remain highly suspicious of a central broncho-occlusive lesion on the left side.

  • Image E. Cut surface of lung, following pneumonectomy, showing massive mucous impaction of the major airways and almost complete distal consolidation.

  • Image F. Mucous containing Charcot-Leyden crystals, stained with H & E

  • Image G. Sheets of eosinophils

  • Image H. Bronchial mucosa under H & E stain showing numerous eosinophils deep to the mucosa, and mucus in the lumen of the bronchiole.

  • Image I. Grocott (silver) stain showing branching septate hyphae fairly typical of Aspergillus in mucus. The apparent right angle branching is unusual (Low power mag.).

  • Image J. Grocott (silver) stain showing branching septate hyphae fairly typical of Aspergillus in mucus. The apparent right angle branching is unusual (High power mag.)..

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The patient underwent a pneumonectomy because of the severity of her disease process, and uncertainty about the diagnosis, prior to serology results being obtained.

Serology showed an IgE of 2600, with a strongly positive Aspergillus RAST test and weakly positive Aspergillus precipitins. Material removed at bronchoscopy showed eosinophilia. These features confirm a diagnosis of allergic bronchopulmonary aspergillosis (ABPA).

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© Fungal Infection Trust

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