High  attenuation  mucus  impaction  in  patients  with  allergic  bronchopulmonary  aspergillosis:   Objective  criteria  on  high  resolution  computed  tomography  and  correlation  with  serological   parameters

Mandeep Kumar Garg

High attenuation mucus impaction in patients with allergic bronchopulmonary aspergillosis: Objective criteria on high resolution computed tomography and correlation with serological parameters

Mandeep Kumar Garg

Postgraduate Institute of Medical Education and Research, India

: J Diagn Tech Biomed Anal

Abstract

Aims & Objectives: The purpose of this prospective study was to correlate the high resolution computed tomography (HRCT) finding of mucoid impaction including high attenuation mucus (HAM) impaction, with immunological parameters in patients with allergic bronchopulmonary aspergillosis (ABPA) and to propose objective criteria for HAM. Materials & Methods: The institutional Review Board approved the study and informed written consent was obtained from all patients. One hundred consecutive patients diagnosed as ABPA between June 2012 and December 2013 undergoing HRCT chest were enrolled. Each HRCT chest was evaluated for central bronchiectasis, mucoid impaction and the number of affected bronchial segments. CT attenuation values and mean CT density of mucoid impaction were calculated; and based on that patients were classified into HAM and Non-HAM group. Immunological severity of the disease was assessed in terms of total IgE, specific IgE and absolute eosinophil count. Results: Patients of ABPA with HAM impaction on HRCT were found to have significantly higher levels of total IgE (P<0.001), specific IgE (P=0.03) and number of bronchial segments affected (P<0.001) compared to non-HAM group. We found CT density of 70 Hounsefield Units (HU) as an adequate cut-off value for HAM impaction and CT value of >100 HU correlated well with immunological severity in ABPA. Conclusion: There is a statistically significant relationship between absolute CT values of HAM impaction on HRCT and immunological severity in ABPA.