대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pleuropulmonary Paragonimiasis

Radiologic Findings

About 2 cm sized subpleural nodule is seen in left upper lobe, containing fluid and gas attenuation within it. Moderate to large amount of pleural effusion is seen in left hemithorax with diffuse thin pleural enhancement.
Laboratory findings show peripheral eosinophilia and positive skin test for Paragonimus. Confirmative diagnosis was made by serologic test for Paragonimus-specific IgG antibody by micro-ELISA.

Brief Review

Pleuropulmonary paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm in the early stage and by formation of cysts around the worm later on. The purpose of this study was to describe the radiologic manifestations of pleuropulmonary paragonimiasis, with special emphasis on the worm cyst and worm migration track. We retrospectively studied 71 patients who had evidence of pleuropulmonary paragonimiasis on chest radiographs (n = 71) and CT scans (n = 17). The diagnosis was based on the detection of eggs or on positive antibody tests. On chest radiographs, 59 patients (83%) had pulmonary lesions and 43 patients (61%) had pleural lesions. Pulmonary findings included patchy air-space consolidation (n = 37) with or without cystic changes; ring shadows (n = 16); and peripheral linear opacities (n = 29), which were more prominent in patients with pleural effusion. Twelve patients (17%) had bilateral pleural effusions or pneumothoraces. On CT scans, round low-attenuation cystic lesions (5-15 mm), filled either with fluid (n = 5) or gas (n = 5), were characteristically seen within the consolidation. Peripheral linear opacities seen on radiographs were suggestive of worm migration tracks on CT scans. CT may reveal an intracystic worm. Although the findings vary depending on the stage of the disease, findings on chest radiographs are usually typical of paragonimiasis. CT provides more specific information about the worm cyst and the worm migration track.

References

Im JG et al. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. Am J Roentgenol. 1992 Jul;159(1):39-43

Keywords

Lung, Pleura, Infection, Eosinophilic lung disease,