Imaging evaluation of mucoid impaction is important in differentiating allergic bronchopulmonary aspergillosis (ABPA) from other severe asthma cases with or without fungal sensitization. We encountered a case of mucoid impaction in a 62-year-old man with severe asthma who was positive for anti-Aspergillus IgG antibodies; however, subsequent examination revealed that the cause of wheezing and mucoid impaction was broncholith. While broncholiths can be a direct cause of wheezing due to the associated airway narrowing, mucosal damage caused by broncholiths or fungi attached to them may be an exacerbating factor for asthma. Moreover, mucoid impaction is actually a rare manifestation of broncholiths. Broncholithiasis should be considered in the differential diagnosis of ABPA and other conditions involving mucoid impaction.