Correct!
2. The diagnosis of ABPA is based on the presence of major criteria

ABPA should be suspected in patients with asthma or cystic fibrosis. ABPA is often seen in difficult to control asthma but can also be present in patients with clinically mild asthma. ABPA may be more common in the cystic fibrosis population than the asthma population. The diagnosis of ABPA is made based on the major criteria outlined below.  There is some debate about how many of the major criteria being present are necessary for the diagnosis. Central bronchiectasis is often seen with ABPA but not necessary for an accurate diagnosis and there is serologic ABPA without the presence of central bronchiectasis. The pathology of ABPA is not completely understood but believed to be due to TH2 cell response leading to elevated immunoglobulins and IL-8 which leads to eosinophilic infiltration, mycotoxin and proteolytic enzymes which eventually cause airway destruction, bronchiectasis and mucus plugging. It is not an infection with Aspergillus but rather a TH2 cell response to Aspergillus. An aspergilloma is a fungal ball that grows inside an established lung cavity from prior disease. It is a completely unrelated process to ABPA.

1. Major Criteria for ABPA:
2. History of asthma
3. Skin reactivity
4. Increased IgE – generally >1000
5. Increased Aspergillus specific IgE and IgG
6. Positive serum precipitin
7. Peripheral eosinophila
8. Radiographic opacities
9. Central bronchiectasis

Minor Criteria for ABPA – Currently not part of the diagnosis.

1. Aspergillus positive sputum culture
2. Expectoration of brown mucus
3. Delayed skin test for Aspergillus

Which of the following radiographic abnormalities are commonly present in ABPA? (Click on the correct answer to proceed to the fourth of six panels)

1. Central bronchiectasis with “finger-in-glove” opacities
2. Diffuse patchy areas of consolidation
3. Lobar or segmental collapse
4. Signet ring shadows
5. All of the above

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