Stepwise diagnostic evaluation for allergic bronchopulmonary aspergillosis (ABPA)

This figure represents a simplified approach to the diagnosis of ABPA based on criteria devised by the International Society for Human and Animal Mycology. This algorithm is intended for use in conjunction with additional UpToDate content. For additional details, refer to UpToDate topics on clinical manifestations and diagnosis of ABPA.

A. fumigatus: Aspergillus fumigatus; CVID: common variable immunodeficiency; EGPA: eosinophilic granulomatosis with polyangiitis; HRCT: high-resolution computed tomography; IgE: immunoglobulin E; PCD: primary ciliary dyskinesia.

* Recent testing does not need to be repeated; blood eosinophil count may be historical.

¶ Radiologic manifestations of ABPA include fleeting opacities, bronchiectasis, and findings related to mucoid impaction and bronchial obstruction. Bronchiectasis most frequently affects the upper and middle lobes and central rather than peripheral bronchi. Other findings on HRCT include mucus impaction, high-attenuation mucus, centrilobular nodules, tree-in-bud opacities, atelectasis, peripheral airspace consolidation or ground-glass attenuation, and mosaic perfusion or air trapping.

Adapted from: Agarwal R, Sehgal IS, Muthu V, et al. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. Eur Respir J 2024; 63:2400061.

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Stepwise diagnostic evaluation for allergic bronchopulmonary aspergillosis (ABPA)