Weekly Chest CasesArchive of Old Cases

Case No : 1125 Date 2019-05-21

Add to Favorites

  • Courtesy of Young Joo Suh, Hye-Jeong Lee / Severance Hospital, Yonsei University College of Medicine
  • Age/Sex 40 / F
  • Chief Complainthemoptysis
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8

Diagnosis With Brief Discussion

Diagnosis
Pulmonary paragonimiasis
Radiologic Findings
Figure 1. Initial chest radiograph shows multifocal poorly defined patchy opacities in bilateral lung fields.
Figure 2-6. Chest CT images show ill-defined patchy consolidation in the RUL, and other two subpleural mass-like consolidations in the lingular segment and RLL. Heterogeneous enhancement with internal lobulated low attenuation foci and air bubbles are seen within consolidation. Ill-defined peribronchial GGOs are combined in the RML and BLL, suggestive of combined hemorrhage.
Figure 7-8. Follow-up CT scans after 5 months show improvement of previous consolidation in RUL, but a cavitary nodule is newly seen in the RUL.
Considering the possibility of vasculitis such as granulomatosis with polyangitis, she underwent VATS wedge resection of lingular segment, and pathology showed presence of parasite eggs with chronic granulomatous inflammation and necrosis, which can morphologically suggest paragonimus infection. Serum P. Westermani IgE Ab (+) was positive.
Brief Review
Pulmonary paragonimiasis is a food-borne parasitic disease caused by the lung fluke Paragonimus westermani, which is endemic in Southeast Asia and the Far East.
The most common symptoms are intermittent hemoptysis or blood-tinged sputum and cough.
After ingested by humans, Paragonimus excyst in the small intestine, and the larvae penetrate through intestinal wall to gain access to the peritoneal cavity. Several weeks later, the organism travels through the diaphragm on its way to the pleural space. Next they enter the lung, where they mature to adult flukes and produce cysts that contain eggs. Paragonimiasis typically results in single of multiple 1- to 4-cm cystic spaces containing reddish brown mucinous fluid. When erosion occurs into a draining airways, the contents of the cyst may be coughed up or may spread to other portions of the lung parenchyma and result is exudative or hemorrhagic pneumonia.
The imaging manifestations of disease parallel to the life cycle of the parasites. The characteristic CT features of pulmonary paragonimiasis are round low attenuation cystic lesions filled with fluid or gas. CT scan also showed air-space consolidation, nodules, worm migration track, and bronchiectasis. The prevalence of pleural effusion varies.
Please refer to
Case 259, Case 295, Case 349, Case 409, Case 502, Case 537, Case 585, Case 612, Case 684, Case 828, Case 909, Case 965, Case 1021, Case 1029, Case 1075, Case 1113,
KSTR Imaging Conference 2014 Spring  Case 1 ,
KSTR Imaging conference 2010 Summer  Case 6 ,
KSTR imaging conference cases 2010 Sprng  Case 4 ,
KSTR Imaging conference 2009 Summer  Case 12 ,
KSTR Imaging Conference 2005 Spring  Case 5 ,
KSTR Imaging Conference 2004 Spring  Case 7 ,
KSTR Imaging Conference 2004 Spring  Case 7,
References

1. Kim TS et al. Pleuropulmonary Paragonimiasis: CT Findings in 31 Pateints. AJR 2005; 185: 816-821
2. Henry TS et al. Chest CT Features of North American Paragonimiasis. AJR 2012; 198: 1078-1083
3. KN Jeon, MJ Park, KS Bae, HY Choi, HC Choi, JB Na, et al. J Korean Soc Radiol 2013;69:365-371
Keywords
Pulmonary, Paragonimiasis,

No. of Applicants : 75

▶ Correct Answer : 39/75,  52.0%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - , Korea (South) HYEYOUNG CHOI
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) JIYEON HAN
  • - Other , Korea (South) JUWON KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan NAOMI YUASA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - , Korea (South) JANG SEONG WON
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 7/75,  9.3%
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - istanbul , Turkey AYHAN YILMAZ
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

This website is optimized for IE 10 and above.