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Weekly Chest CasesArchive of Old Cases

Case No : 1075 Date 2018-06-04

  • Courtesy of Eun-Ju Kang, M.D., Ki-Nam Lee, M.D. / Dong-A University Hospital
  • Age/Sex 46 / M
  • Chief ComplaintAcute left chest pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Paragonimiasis
Radiologic Findings
Figure 1. Chest PA shows ill-defined patchy increased opacity in left upper lung zone. Bilateral pleural effusion is also noted.
Figure 2-3. Axial CT images show patchy consolidations and surrounding ground glass opacities in left upper lobe subpleural area.
Figure 4. Axial CT image at lower level shows ill-defined patchy area of subpleural consolidation with GGOs and mild pneumothorax in LUL.
Figure 5. Coronal CT image shows multifocal consolidations with GGOs in BULs and pneumothorax in left lung.
Figure 6. After 5 days of albendazole treatment, follow up axial CT image shows decreased extent of previous lesions but remnant lesion which looks like worm migration track is seen. Bilateral pleural effusion is newly developed.
Brief Review
He had history of frequent ingestion of raw freshwater crab or crayfish and abnormal lab finding such as eosinophilia in peripheral blood examinations.
Pulmonary paragonimiasis is a food-borne parasitic disease caused by the lung fluke Paragonimus westermani, which is endemic in Southeast Asia and the Far East. It has a complex life cycle and ingested metacercariae excyst in the small intestine, migrate through the intestinal wall and enter the abdominal cavity. Next they penetrate the diaphragm and pleura and enter the lung in three to eight weeks, where they develop into the adult worms.
Typical pulmonary symptoms are fever, chest pain, and respiratory symptoms, including a chronic cough with homoptysis. Peripheral blood examinations can show leukocytosis and eosinophilia in many patients.
Paragonimiasis may be categorized into pulmonary, pleuropulmonary and extra-pulmonary forms. Radiographically, paragonimiasis is dependent on which stage in the development of the disease has been currently reached. The most common manifestation observed was pleural lesions from simple pleural thickening to bilateral hydropneumothorax. The characteristic CT features of pulmonary paragonimiasis were round low attenuation cystic lesions filled with fluid or gas. CT scan also showed air-space consolidation, nodules, worm migration track, and bronchiectasis. The prevalence of pleural effusion varies.
The diagnostic criteria of paragonimiasis are based on clinical history, radiological findings, absolute eosinophilia, positive findings on a serological test, or detection of eggs or worms in sputum or bronchoalveolar lavage (BAL) fluid or stool or in a pathologic specimen. A specific IgG antibody test using the ELISA is helpful both in suggesting a diagnosis and in ruling out infections. Praziquantel is the drug of choice for both pulmonary and extra-pulmonary paragonimiasis.
References
1. Jeon K, Koh W, Kim H, Kwon OJ, Kim TS, Lee K, et al. Chest 2005; 128:1423-1430
2. Kim TS, Han J, Shim SS, Jeon K, Koh WJ, Lee I, et al. AJR 2005; 185:616-621
3. Shambhu KS, Silin D, Yi L, Ping Y, Oormila G, Manu C, et al. Radiology of Infectious Diseases 2016;3:66-73
4. KN Jeon, MJ Park, KS Bae, HY Choi, HC Choi, JB Na, et al. J Korean Soc Radiol 2013;69:365-371
Keywords
Lung, Pleura, Infection, Parasite,

No. of Applicants : 105

▶ Correct Answer : 73/105,  69.5%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - , Korea (South) YOONAH SONG
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - , Korea (South) CHOHEE KIM
  • - Soonchunhyang University College of Medicine , Korea (South) GOUN CHOI
  • - Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Other , Korea (South) GUNSU KIM
  • - Daegu Fatima Hospital , Korea (South) KIBEOM KIM
  • - The Jikei university , Japan TAKU GOMI
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Korea (South) HYO JAE LEE
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Busan National University Hospital , Korea (South) KIM JEONG MYEONG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Korea (South) JANG SEONG WON
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - DECRH, Fredericton , Canada RAM P GALWA
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - , Korea (South) SUNGEUN YUN
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Korea (South) JONGSUN LEE
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Kyemyung University Dongsan Hospital , Korea (South) DONG HYEON KIM
  • - Samsung Medical Center , Korea (South) YOON KYUNG KIM
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 1/105,  1.0%
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
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