ABPA complicated by severe varicose bronchiectasis

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.   

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