Diaphragmatic Eventration Masquerading as Lobar Collapse in Severe ABPA

Area of Science:

• Pulmonology
• Radiology
• Medical Diagnostics

Background:

• Allergic bronchopulmonary aspergillosis (ABPA) typically presents with mucus plugging and atelectasis.
• Diaphragmatic abnormalities can sometimes mimic pulmonary collapse on imaging.

Purpose of the Study:

• To describe a rare case of acute allergic bronchopulmonary aspergillosis (ABPA) where diaphragmatic eventration mimicked lobar collapse.
• To highlight the importance of advanced imaging and functional tests in differentiating structural mimics from true atelectasis.

Main Methods:

• Case presentation of a 62-year-old asthmatic patient with acute ABPA.
• Utilized high-resolution computed tomography (HRCT) for detailed lung and diaphragm imaging.
• Performed positional spirometry to assess diaphragmatic function.

Main Results:

• The patient presented with symptoms suggestive of mucus-induced atelectasis.
• Severe right-sided diaphragmatic elevation was identified.
• HRCT and positional spirometry confirmed massive diaphragmatic eventration, not lobar collapse.

Conclusions:

• Diaphragmatic eventration can present as a rare structural mimic of lobar collapse.
• Integrated use of HRCT and functional tests like positional spirometry is crucial for accurate diagnosis in complex respiratory cases.
• This case underscores the diverse presentations of ABPA and the need to consider structural mimics in differential diagnosis.