대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 715 Date 2011-07-12

  • Courtesy of Ki-Nam Lee, Dong Won Kim / Dong-A University Hospital
  • Age/Sex 28 / F
  • Chief ComplaintBlood tinged sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Paragonimiasis
Radiologic Findings
Chest PA shows well defined multiple small nodular opacities and thin walled cavitary lesions in RUL. Chest CT images show multiple lobular nodules and irregular tubular shape cavitary lesions (irregular tracks or burrows) in RUL and RLL superior segment. These nodules and cavity are located in peripheral area. There is no enlarged lymph node in the mediastinum and hilum. The patient had peripheral blood eosinophilia and PW antibody was positive.
Brief Review
Paragonimiasis is caused by flukes of the genus Paragonimus; the most frequent etiologic agent is Paragonimus westermani through the ingestion of raw or undercooked freshwater crabs or crayfish infected with the metacercaria. The main endemic areas are east Asia, Southeast Asia, Latin America and Africa. The lung is the target organ. The penetration of juvenile worms through the diaphragm into the pleural cavity can cause pleural effusion (37%) or pneumothorax (17%). The most common findings on CT consist of subpleural or subfissural single or multiple nodules 1-4 cm that frequently contain a necrotic low attenuation area or cavitation. There are commonly associated subpleural linear opacities and focal pleural thickening adjacent to a pulmonary nodule. The appearance of pulmonary lesions is influenced by the stage of the infection and the surrounding tissue reaction. Early findings are caused by the migration of juvenile worms and focal airspace consolidation, linear opacities, pleural effusion, pneumothorax, or hydoropneumothorax. Later findings result from worm cysts and include thin walled cysts, mass-like consolidation, nodules, and bronchiectasis. CT also may show a subpleural streaky opacity 2-7 mm thick and 5-60 mm long connecting the pleura and the nodule, which is presumed to be a worm migration track (burrow track).
Diagnosis is confirmed by detecting parasite eggs in the sputum, bronchial washing fluid, or lung biopsy specimens or by serologic test, most commonly enzyme-linked immunosorbent assay.
References
1. Im JG, Whang HY, Kim WS, et al. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR 1992;15-:39-43.
2. Im JG, Kong Y, Shin YM, et al. Pulmonary paragonimiasis: clinical and experimental studies. Radiographics 1993; 13:575-586.
3. Kim TS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR 2005; 185:616-621.
4. Mart�nez S, Restrepo CS, Carrillo JA, et al. Thoracic Manifestations of Tropical Parasitic Infections: A Pictorial Review. RadioGraphics. 2005; 25:135-155.
Keywords
lung , infection, parasitic,

No. of Applicants : 104

▶ Correct Answer : 25/104,  24.0%
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Okayama University , Japan Akihiro Tada
  • - HSC , Brazil Diogo Pinheiro
  • - CHRU lille , France manuel toledano
  • - NZOZ Diagnostica , Poland Krzysztof Owsianny
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
  • - CNUH , Korea (South) Seoin Jeong
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - Chonnam national univ. hospital , Korea (South) Choi SEUL Gi
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Asan Medical Center , Korea (South) Sanghyun Choi
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
▶ Correct Answer as Differential Diagnosis : 17/104,  16.3%
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - newtongyoung hospital , Korea (South) park ji hoon
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Catholic medical center , Korea (South) hyuna kim
  • - sunder lal jain hospital , India sanjeev vachher
  • - snuh , Korea (South) Choo jiyung
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - NASA SCANS , India RAKESH BHATIA
  • - IRSA , France jean-luc BIGOT
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Okayama university , Japan Mayu Uka
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - KUMC ansan , Korea (South) kihwan kim
▶ Semi-Correct Answer : 1/104,  1.0%
  • - Saga University , Japan Tetsuya Kondo
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