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Weekly Chest CasesArchive of Old Cases

Case No : 1113 Date 2019-02-25

  • Courtesy of Kim Yongsang, Woo Jeong Joo / Eulji Hospital, Eulji University of Medical School
  • Age/Sex 38 / F
  • Chief ComplaintLeft pleuritic chest pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

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
Keywords
lung, Parasitic infection,

No. of Applicants : 86

▶ Correct Answer : 69/86,  80.2%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - The University of Tokyo Hospital , Japan MASAFUMI KAIUME
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Chonbuk National University Hospital , Korea (South) SANGHEON KIM
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - , Korea (South) CHOHEE KIM
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - MD , India DEEPANDER SINGH RATHORE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - , Japan HISATAKA ITO
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Gyeongsang National University Hospital , Korea (South) KWON HWANWOONG
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - , Korea (South) MINJEE KIM
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Japanese Red Cross Wakayama Medical Center , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 7/86,  8.1%
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Kashan University of Medical Sciences, kashan , Iran EBRAHIM RAZI
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - TB centre kasaragod. , India rikhy krishnan
▶ Semi-Correct Answer : 2/86,  2.3%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - , China SHENG HUA JIANG
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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