Archive of Old Cases
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- Archive of Old Cases
- 2007
Case No : 485 Date 2007-02-12
- Courtesy of Woon-Jung Kwon, MD. / Ulsan University Hospital, Ulsan, Korea
- Age/Sex 36 / M
- Chief ComplaintDyspnea, azotemia & hypoglycemia He worked in Nigeria for 1 year
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary edema and ARDS due to severe malaria
- Radiologic Findings
- At admission, the chest radiograph shows ground glass opacities in both lung fields. On follow-up chest radiograph obtained 3 days later, ground glass opacities in both lung fields are slightly absorbed.
Initial HRCT images show diffuse ground glass opacities and consolidations in entire both lungs. Non-contrast enhanced mediastinal window image represents normal sized heart without pleural effusion in the both hemithoraces. These chest radiographs and CT images demonstrate noncardiogenic pulmonary edema in this patient.
He was diagnosed as plasmodium falciparum infection in outside hospital in Nigeria. - Brief Review
- Malaria is caused by obligate intraerythrocystic protozoa of the genus Plasmodium. Plasmodia are primarily transmitted by the bite of an infected female Anopheles mosquito, but infections can also occur through exposure to infected blood products (transfusion malaria) and by congenital transmission.
Acute lung injury usually occurs a few days into the disease course. It may develop rapidly, even after initial response to antimalarial treatment and clearance of parasitemia. Pulmonary edema is usually noncardiogenic and may progress to acute respiratory distress syndrome (ARDS) with an increased pulmonary capillary permeability.
Radiologic signs of pulmonary edema include a generalized increase in interstitial markings followed by increasing areas of fluffy shadowing that eventually may cover both lung fields. These radiologic signs of malaria-induced pulmonary edema usually develop 6 to 24 hours after the onset of dyspnea. Less typical features include interstitial infiltrates alone, thickening of interlobular septal lines, and minor and major fissures. Pleural effusion is rare. - References
- 1. W.R.J Taylor, N.J White. Malaria and the lung Clin Chest Med 2002 Jun;23(2):457-468
2. Trampuz A, Jereb M, Muzlovic I, Prabhu RM. Clinical review: Severe malaria.
Crit Care. 2003 Aug;7(4):315-23. Epub 2003 Apr 14. Review. - Keywords
- Lung, Infection, Parasitic infection,
No. of Applicants : 36
- ▶ Correct Answer : 8/36, 22.2%
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- - Marien Hospital, Hamm, Germany Davis Chiramel
- - E-Da Hospital, Taiwan Yu-Feng Wei
- - Hospital Sotiria, Athens, Greece Vasilios Tzilas
- - Ekh-Berlin, Germany Michael Weber
- - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- - Kyunghee University Medical Center, Korea Su Youn Sim
- - China Medical University Hospital,Taiwan Jun-Jun Yeh
- - Changi General Hospital, Singapore Angeline Poh
- ▶ Correct Answer as Differential Diagnosis : 3/36, 8.3%
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- - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- - Pgimer, Chandigarh, India Ram Prakash Galwa
- - Asan Medical Center, Korea Eun Jin Chae
- ▶ Semi-Correct Answer : 10/36, 27.8%
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- - Vital Imaging Centre, Mumbai,India Ganesh Agrawal
- - IRSA, La Rochelle, France Jean-Luc Bigot
- - Homs National Hospital, Homs, Syria Rami Abou Zalaf
- - IRSA, La Rochelle, France Denis Chabassiere
- - Regional Imaging, Riverina, Australia Rashid Hashmi
- - KAUMS, Kashan, Iran Ebrahim Razi
- - Yongsan Hospital, Chung-Ang University,Korea Jae Seung Seo
- - Doctors Hospital, Nassau, Bahamas N.B.S.Mani
- - A.S.C.S. Safwa,Saudi Arabia Kalari.Adi Narayana
- - Nirman Hi-Tech Diagnostic Centre, Mumbai. India Minal Seth
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