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Weekly Chest CasesArchive of Old Cases

Case No : 684 Date 2010-12-06

  • Courtesy of Ga Jin Han, Yeon Joo Jeong, Kun-Il Kim / Pusan National University Hospital
  • Age/Sex 31 / F
  • Chief ComplaintHemoptysis
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8

Diagnosis With Brief Discussion

Diagnosis
Pleuropulmonary paragonimiasis
Radiologic Findings
Radiologic finding: Chest radiograph (Fig.1) shows multiple ill defined nodules and mass like consolidation in right lung with loculated right pleural effusion. Non-enhanced chest CT scans (Figs. 2A and 2B) show multiple subpleural and subfissural nodules and mass with focal calcification in right lung. The subpleural mass has subtle peripheral enhancement on contrast-enhanced CT scans (Figs. 2C and 2D). Coronal lung window images (Figs. 2E-2G) of chest CT scan show adjacent small centrilobular nodules in right lower lobe in addition with subpleural and subfissural nodules.
Brief Review
The patient had a history of eating of raw freshwater crab 5 years ago. Initial peripheral eosinophil count was not available, but Paragonimus-specific IgG antibody by enzyme-linked immunosorbent assay was 4.37 (normal range, <1). Egg of P. westermani (Fig. 3) was found in the bronchial washing fluid.
Pleuropulmonary paragonimiasis (PP) is a parasitic disease caused by P. westermani. It is contracted through the ingestion of raw or partially cooked freshwater crabs or crayfish infected with the metacercaria. Diagnosis is confirmed by the presence of parasitic eggs in the sputum, pleura, or BAL fluid. Intradermal and serologic tests are also available. Typical CT findings in PP are poorly marginated subpleural or subfissural nodule that frequently contains a low-opacity necrotic area, focal pleural thickening, and subpleural linear opacities leading to a necrotic peripheral pulmonary nodule. Other common CT findings include adjacent bronchiectasis, areas of ground glass opacity, and pleural effusion or pneumothorax.
References
1. Jeong YJ, Kim KI, Seo IJ et al. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 2007; 27:617-639
2. Kim TS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR 2005; 185:616-621.
Keywords
Lung, Pleura, Infection, Parasitic infection,

No. of Applicants : 98

▶ Correct Answer : 17/98,  17.3%
  • - Mie-chuo hosp. , Japan Hitoshi KODERA
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - chonnam university hospital , Korea (South) shin hyun
  • - Osaka University , Japan Osamu Honda
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Chonnam National University , Korea (South) se hee Jung
  • - CNUH , Korea (South) Seoin Jeong
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Chonbuk National University Hospital , Korea (South) Sungkwan Kim
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Department of Radiology, Chonnam National University Hospital , Korea (South) Hyungjun Kim
  • - Chonnam national univ. hospital , Korea (South) Choi seul Gi
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Correct Answer as Differential Diagnosis : 13/98,  13.3%
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - McGill University Health Center , Canada Alexandre Semionov
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - Catholic medical center , Korea (South) hyuna kim
  • - Asan Medial center , Korea (South) Chaehun Lim
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - chest hospital , India k bhaskar
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