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High-attenuation mucus in allergic bronchopulmonary aspergillosis
  1. Irfan Ismail Ayub1,
  2. Padmasani Venkatramanan2
  1. 1Department of Pulmonary Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
  2. 2Department of Pediatrics, Sri Ramachandra Medical College and Hospital, Chennai, Tamilnadu, India
  1. Correspondence to Dr Irfan Ismail Ayub, Pulmonary Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India; iia{at}rediffmail.com

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A 9-year-old girl, on maintenance therapy for asthma, presented with 3 weeks of increasing dyspnoea. She had tachypnoea, hypoxaemia and bilateral crepitations on chest auscultation. Blood investigations revealed anaemia, leucocytosis and peripheral eosinophilia (table 1). Chest X-ray showed bilateral midzone infiltrates (figure 1A). A chest high-resolution CT (HRCT) scan performed after absence of clinical improvement with therapy, revealed bilateral central varicoid bronchiectasis, with tubular mucoid impaction in dilated bronchi in right lower lobe, called the ‘toothpaste sign’ (figure 2A).1 Within it is an area of higher …

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Footnotes

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  • IIA and PV contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.