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Master Thesis

Les bronchocèles denses : un marqueur TDM précoce d'aspergillose bronchopulmonaire allergique chez les patients atteints de mucoviscidose

Abstract : Background: high attenuation mucus plugs (HAM) on CT have been considered recently as a characteristic sign of Allergic bronchopulmonary aspergillosis (ABPA). The onset of HAM development in ABPA remains unknown. The Cystic Fibrosis Foundation Consensus Conference (CFFC) has developed criteria for the diagnosis of ABPA in cystic fibrosis (CF). We hypothesised that HAM might be present before the fulfilment of CFFC diagnostic criteria allowing for an early stage diagnosis and treatment in CF patients. Materials and Methods: this was a retrospective study including 103 patients with CF between January 2015 and May 2020. Serological, CT and functional data were collected. Presence of HAM was evaluated in all patients. Early HAM (eHAM) was defined as the presence of HAM before the diagnostic criteria of CFFC were fulfilled. Comparison of means was assessed using Student’s t-test or Mann-Whitney test and proportions using the Fisher exact test. Diagnostic performance was assessed by calculating sensitivity (Se), specificity (Sp), positive predicted value (PPV) and negative predicted value (NPV). Results: 28 patients (28/103) were considered as ABPA-positive during the collection period. 20 patients (20/28), have showed HAM at CT scan. Among them, 9 patients had early HAM. No HAM was found in ABPA-negative patients. The median total IgE at the time of eHAM onset was 276 IU/ml, which significantly increases to reach a median of 600 IU/ml (p <0.01) in the follow-up when the CFFC diagnostic criteria were fulfilled. Sensitivity and specificity of the presence of HAM to diagnose ABPA were 71% and 100% respectively, for a PPV and NPV of 100% and 90% respectively. Conclusion: in patients with cystic fibrosis, HAM are pathognomonic of ABPA and may appear early. This sign should therefore be regarded as an important criterion in the diagnosis of the disease.
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Submitted on : Wednesday, November 18, 2020 - 11:24:17 AM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM
Long-term archiving on: : Friday, February 19, 2021 - 6:58:48 PM


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  • HAL Id : dumas-03011703, version 1



Pierre Lemardele. Les bronchocèles denses : un marqueur TDM précoce d'aspergillose bronchopulmonaire allergique chez les patients atteints de mucoviscidose. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03011703⟩



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