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Correspondence |

Radiologic Criteria for the Diagnosis of High-Attenuation Mucus in Allergic Bronchopulmonary Aspergillosis FREE TO VIEW

Ritesh Agarwal, MD, DM, FCCP; Inderpaul Singh Sehgal, MD, DM; Sahajal Dhooria, MD, DM; Ashutosh Aggarwal, MD, DM, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Ritesh Agarwal, MD, DM, FCCP, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):1109-1110. doi:10.1016/j.chest.2015.12.043
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Published online

We read with interest the article by Alikhan et al in a recent issue of CHEST (December 2015). The authors describe a case of allergic bronchopulmonary mycosis secondary to colonization of a patient’s clarinet by Alternaria. In this article, the authors incorrectly describe high-attenuation mucus as mucus with attenuation higher than that of water.

On computed tomography (CT) scan, high-attenuation mucus is defined subjectively as mucus visually denser than the chest wall or paraspinal skeletal muscle,,; it is defined objectively on a CT scan as having an attenuation value > 70 Hounsfield units. Hyperattenuating mucoid impaction is a pathognomonic feature of allergic bronchopulmonary aspergillosis (100% specificity). If present at diagnosis, it is an independent predictor of poor outcomes in allergic bronchopulmonary aspergillosis.,, In addition, several aspects of discussion in the article by Alikhan et al point toward research performed by our group, such as the estimate of the prevalence of high-attenuation mucus and the mechanistic explanations regarding the occurrence of masses in allergic aspergillosis. However, none of our work has been cited.

References

Alikhan M.M. .Kraft C.S. .Shih J.A. .Lee F.E. .Auffermann W.F. .Berkowitz D.M. . A 68-year-old musician with cough, wheezing, and a lung mass. Chest. 2015;148:e181-e183 [PubMed]journal. [CrossRef] [PubMed]
 
Logan P.M. .Muller N.L. . High-attenuation mucous plugging in allergic bronchopulmonary aspergillosis. Can Assoc Radiol J. 1996;47:374-377 [PubMed]journal. [PubMed]
 
Agarwal R. .Gupta D. .Aggarwal A.N. .Saxena A.K. .Chakrabarti A. .Jindal S.K. . Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. Chest. 2007;132:1183-1190 [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Khan A. .Gupta D. .Aggarwal A.N. .Saxena A.K. .Chakrabarti A. . An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. PLoS One. 2010;5:e15346- [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Maskey D. .Aggarwal A.N. .et al Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS One. 2013;8:e61105- [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Gupta D. .Aggarwal A.N. .et al Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med. 2010;104:204-210 [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Aggarwal A.N. .Garg M. .Saikia B. .Gupta D. .Chakrabarti A. . Allergic bronchopulmonary aspergillosis with aspergilloma: an immunologically severe disease with poor outcome. Mycopathologia. 2012;174:193-201 [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Aggarwal A.N. .Sehgal I.S. .Dhooria S. .Behera D. .Chakrabarti A. . Utility of IgE (total and Aspergillus fumigatus specific) in monitoring for response and exacerbations in allergic bronchopulmonary aspergillosis. Mycoses. 2016;59:1-6 [PubMed]journal
 
Agarwal R. .Srinivas R. .Agarwal A.N. .Saxena A.K. . Pulmonary masses in allergic bronchopulmonary aspergillosis: mechanistic explanations. Respir Care. 2008;53:1744-1748 [PubMed]journal. [PubMed]
 

Figures

Tables

References

Alikhan M.M. .Kraft C.S. .Shih J.A. .Lee F.E. .Auffermann W.F. .Berkowitz D.M. . A 68-year-old musician with cough, wheezing, and a lung mass. Chest. 2015;148:e181-e183 [PubMed]journal. [CrossRef] [PubMed]
 
Logan P.M. .Muller N.L. . High-attenuation mucous plugging in allergic bronchopulmonary aspergillosis. Can Assoc Radiol J. 1996;47:374-377 [PubMed]journal. [PubMed]
 
Agarwal R. .Gupta D. .Aggarwal A.N. .Saxena A.K. .Chakrabarti A. .Jindal S.K. . Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. Chest. 2007;132:1183-1190 [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Khan A. .Gupta D. .Aggarwal A.N. .Saxena A.K. .Chakrabarti A. . An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. PLoS One. 2010;5:e15346- [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Maskey D. .Aggarwal A.N. .et al Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS One. 2013;8:e61105- [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Gupta D. .Aggarwal A.N. .et al Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med. 2010;104:204-210 [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Aggarwal A.N. .Garg M. .Saikia B. .Gupta D. .Chakrabarti A. . Allergic bronchopulmonary aspergillosis with aspergilloma: an immunologically severe disease with poor outcome. Mycopathologia. 2012;174:193-201 [PubMed]journal. [CrossRef] [PubMed]
 
Agarwal R. .Aggarwal A.N. .Sehgal I.S. .Dhooria S. .Behera D. .Chakrabarti A. . Utility of IgE (total and Aspergillus fumigatus specific) in monitoring for response and exacerbations in allergic bronchopulmonary aspergillosis. Mycoses. 2016;59:1-6 [PubMed]journal
 
Agarwal R. .Srinivas R. .Agarwal A.N. .Saxena A.K. . Pulmonary masses in allergic bronchopulmonary aspergillosis: mechanistic explanations. Respir Care. 2008;53:1744-1748 [PubMed]journal. [PubMed]
 
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