(A) Chest radiograph in 1969 in a patient aged 24 with asthma with bronchiectasis showing mild left mid-zone shadows consistent with bronchiectasis and a small area of opacification in the left base, with left apical scarring. New streaky shadowing is projected over the left heart border. (B) Chest radiograph in same patient in 1981 (aged 36) following first radiological feature of allergic bronchopulmonary aspergillosis (ABPA; clearance of the left upper lobe shadowing after physiotherapy and corticosteroids). Compared with 1969, there is now extensive bronchiectasis in the left lower and right lower lobes. (C) Chest radiograph in same patient in 1985 (aged 40), with first clue of chronic cavitary pulmonary aspergillosis. The chest radiograph shows development of right upper pleural thickening with further volume loss, without extensive fibrotic disease. There is more obvious new cavity formation in the left upper lobe with unchanged thickened bronchi in the left mid zone. A mild scoliosis has developed. (D) Chest radiograph in same patient in 1995 (aged 50), showing interval development of scoliosis with bilateral upper lobe pleural thickening, worse on the right, with cavities in the left upper lobe and fullness of the right upper mediastinum. The features of central bronchiectasis, so characteristic of ABPA, are very prominent. She is significantly disabled by her disease now.
