Bronchopulmonary Aspergillosis

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Broncho-pulmonary aspergillosis occurs in asthmatic individuals, who are sensitised to the aspergillus fungus that is so frequently inhaled with atmospheric air. There is usually ill-defined peri-hilar shadowing with linear shadows. The lungs are large volume. So called 'tramline' shadows are usually visible in the mid to upper zones as fine parallel lines, radiating out from the hila. These are due to interstitial emphysema, which is common in asthma with air-trapping. The air is thought to leak back from the junction of terminal bronchiole with alveoli down the long lymphatics ( Kerley A ) or immediately adjacent soft tissue planes, thereby giving the unbranching parallel line shadows. High eosinophil counts are found in the peripheral blood and saliva. The majority of the pulmonary shadowing is due to pulmonary eosinophilic infiltration. The thickened bronchial walls and mucus plugs contain many eosinophils. Bronchial obstruction and central bronchiectasis are a feature of severe or recurrent bronchopulmonary aspergillosis.

Eosinophilic infiltration of the lung may also occur in parasite infestations that pass through the lungs. Polyarteritis nodosa can be associated with symptoms resembling asthma. If a vasculitis with pulmonary infiltration is preceded by asthma and without diagnostic features in other systemic locations then one would consider the possibility of Churg Strauss syndrome. Commoner in women and susceptible to steroids.

For more information on aspergillosis.

Various anatomic expressions of pathology.

2 cases of aspergillosis in asthma

Ian Maddison 1998