대한흉부영상의학회 Weekly Chest Cases

Case No : 662 Date 2010-07-05

Courtesy of Nara Kim, Jae Seung Seo, SeMin Chong / Department of Radiology, Chung-Ang University Hospital
Age/Sex 21 / M
Chief ComplaintFever for 5 days, chilling sense, cough, PHx.: Discharged from the military service in January, 2010.

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Initial chest PA

Diagnosis With Brief Discussion

Diagnosis: Malaria
Radiologic Findings: Figure 1. Initial chest PA shows subtle pulmonary vascular shadows in both lower lung zones on admission.
Figure 2. Four days later chest PA shows pulmonary edema and bilateral pleural effusion.
Figure 3-7. Chest CT scan shows bilateral pleural effusion and pericardial effusion. Ground glass opacities and consolidations with combined interlobular septal thickening in both lungs are combined. There are multiple small LNs in both hila and mediastinum.
Brief Review: In this case, pleural effusion was improved after 5 days. When we followed up chest X-ray 3 weeks later, the chest X-ray was normal.
Various Plasmodium species such as P. falciparum, P.vivax, P.ovale or P.malariae are responsible for human malaria.
The most common clinical findings are fever, chills, sweating, anemia, leucopenia, and splenomegaly. The diagnosis is usually made by identifying trophozoites or other parasitic forms within the erythrocytes in a thin blood smear or parasites in a thick smear.
Radiographic and CT findings are consistent with noncardiogenic pulmonary edema. Pleural effusion, diffuse interstitial edema, and lobar consolidation may also be seen. Occasionally, bronciolitis obliterans organizing pneumonia has been reported. Eosinophilic pneumonia with bilateral patchy consolidation has also been described in association with the use of pyrimethamine.
ARDS is occasionally the primary manifestation of malaria in the lung and was included in 1990 by the WHO as a criterion for the definition of both severe and complicated malaria. Although the pathophysiologic features of ARDS are still unclear, changes result from vascular injury related to RBC sequestration and destruction, the release of parasite and erythrocyte material into the circulation, and the host response to these events. Severe P.falciparum infection is the type most commonly associated with ARDS.
References: 1. Murray PR, Rosenthal KS, Kobayashi GS, Pfaller M. Medical microbiology. 4th ed. St Louis, Mo: Mosby, 2002.
2. Taylor WR, White NJ. Malaria and the lung. Clin Chest Med 2002; 23:457-468.
3. Yale SH, Adlakha A, Sebo TJ, Ryu JH. Bronchiolitis obliterans organizing pneumonia caused by Plasmodium vivax malaria. Chest 1993; 104:1294-1296.
4. Davidson AC, Bateman C, Shovlin C, Marrinan M, Burton GH, Cameron IR. Pulmonary toxicity of malaria prophylaxis. BMJ 1988; 297:1240-1241.
Please refer to: Case 616
Keywords: Lung, Infection, Parasitic infection,

No. of Applicants : 122

▶ Correct Answer : 4/122, 3.3%

- Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
- Bundang CHA hospital , Korea (South) Sojung Kim
- Bundang CHA hospital , Korea (South) Jung Jin Young
- All India Institute of medical sciences , India Justin Moses

▶ Correct Answer as Differential Diagnosis : 13/122, 10.7%

- Inha University Hospital , Korea (South) Ju Won Lee
- Konkuk university hospital , Korea (South) Jeong Geun Yi
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- Vitalife Clinics , Pune , India. , India Rahul Deshmukh
- ROK air force aerospacemedical center , Korea (South) Daekeon Lim
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Hanyang university Guri hospital , Korea (South) Eung tae Kim
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
- NASA SCANS , India RAKESH BHATIA
- Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
- kovai medical centre , India k bhaskar
- EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 662 Date 2010-07-05

Discussion

No. of Applicants : 122