Discussion
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
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KSTR Imaging conference 2010 Summer Case 6
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KSTR imaging conference cases 2010 Sprng Case 4
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KSTR Imaging conference 2009 Summer Case 12
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KSTR Imaging Conference 2005 Spring Case 5
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KSTR Imaging Conference 2004 Spring Case 7
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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
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Pulmonary, Paragonimiasis,