42 year old male , diagnosed to have a bad asthma 10 years ago, particularly worse since last 4 years, reports to your clinic with chronic respiratory failure, SaO2 = 70 % on room air, Patient has severe obstruction and restriction on spirometry with partial reversibility.

What does the CT image show ? How will you confirm your diagnosis?

Striking finding is extensive bronchiectasis.This overshadows patchy groundglass opacification.

Also note proximal location of the bronchiectasis.Combined with history of poorly controlled asthma the diagnosis is likely to be ABPA.