Patients has history of ABPA complicating long standing asthma. His total IgE has fluctuated between 2,200 and 4,600 KU/L, his Aspergillus IgE between 36.3 and 65.4 kAU/L and Aspergillus IgG from 87-154 mg/L. He has been taking long term itraconazole.
The CT scan (3 cuts from the same scan in 2012) shows background paraseptal and centrilobular emphysema and the distribution of the varicoid bronchiectasis (i.e. upper lobe predominant and central) is consistent with ABPA. There are no areas of consolidation or evidence of interstitial lung disease. Several fluid levels are seen within the airways together with bronchial wall thickening throughout the right hemithorax. There is almost no evidence of exudative small airways disease (i.e. no small airway impaction).
The chest Xrays show mild cardiomegaly. There are background chronic interstitial changes of a coarsened reticulonodular pattern, with an area of more prominent pulmonary fibrotic change in the right mid zone. Minor apical thickening noted.