Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary Paragonimiasis
- Radiologic Findings
- Figure 1. Chest radiograph shows a poorly defined focal opacity in the left upper lobe.
Figure 2-6. Chest CT images show two areas of ill-defined subpleural mass-like consolidation in the LUL and RLL.
Several small air-cysts within the left upper lobe consolidation are observed on lung window setting images. Enhanced scan shows heterogeneous enhancement with internal lobulated low attenuation foci within the RLL consolidation and air bubbles in the LUL lesion. In addition, adjacent pleural reaction is combined at the left upper lobe consolidation.
Figure 7. After albendazole treatment for 1 month, follow-up CT shows resolution of previous consolidation with remnant thin-walled multi-cystic lesion.
Lab. shows eosinophil differentiation 9.5%, eosinophil count 650/ul and P. Westermani IgE (+).
- Brief Review
- Pulmonary paragonimiasis is a parasitic infection caused by flukes of genus Paragonimus. This disease is caused by ingestion of a raw or undercooked freshwater crabs or crayfish infected with the metacercaria or by drinking contaminated water.
The most common symptoms are intermittent hemoptysis or blood-tinged sputum and cough.
After ingested by humans, Paragonimus excyst in the small intestine, and the larvae penetrate through intestinal wall to gain access to the peritoneal cavity. Several weeks later, the organism travels through the diaphragm on its way to the pleural space. Next they enter the lung, where they mature to adult flukes and produce cysts that contain eggs. Paragonimiasis typically results in single of multiple 1- to 4-cm cystic spaces containing reddish brown mucinous fluid. When erosion occurs into a draining airways, the contents of the cyst may be coughed up or may spread to other portions of the lung parenchyma and result is exudative or hemorrhagic pneumonia. The imaging manifestations of disease parallel to the life cycle of the parasites.
- References
- 1. Kim TS et al. Pleuropulmonary Paragonimiasis: CT Findings in 31 Pateints. AJR 2005; 185: 816-821
2. Henry TS et al. Chest CT Features of North American Paragonimiasis. AJR 2012; 198: 1078-1083
3. Walker CM, Chung J. Muller’s imaging of the chest. 2nd ed. Elsvier 2019 Part 14 PP. 297-299
- Please refer to
- Case 1075 Case 1029 Case 965 Case 909 Case 885 Case 828 Case 741 Case 715 Case 684 Case 585 Case 537 Case 527 Case 502
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- Keywords
- lung, Parasitic infection,