Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pleuropulmonary Paragonimiasis
- Radiologic Findings
- Chest PA shows right pneumothorax with apical bullae, patchy infiltrates in right perihilar area and linear and ill-defined small nodular opacities in both lungs.
High-resolution CT scan demonstrates right pneumothorax, multifocal patchy opacities in both lungs, especially subpleural nodular opacities in left upper lobe and linear opacity in right upper lobe and air cyst in right apex.
- Brief Review
- Paragonimiasis is caused by flukes of the genus Paragonimus and the most frequent etiologic agent is Paragonimus westermani. Humans typically acquire the disease by ingesting raw or undercooked crabs or crayfish or by drinking water contaminated by them. The major target organ is the lung, followed by the brain.
Parasites induce inflammatory infiltrate, sometimes granuloma, and cystic cavities. Symptoms include hemoptysis, pleuritic chest pain, and chronic cough, which may produce sputum containing the ova of the infecting organism. The pulmonary change result from chronic inflammation in areas surrounding the worm.
Radiologic manifestations of pulmonary paragonimiasis vary with the stage of the disease. Early findings include pneumothorax or hydropneumothorax, focal air-space consolidation, and linear opacities 2 to 4 mm thick and 3 to 7cm long extending inward from pleura caused by the migration of juvenile worms. Later findings include thin-walled cysts, dense mass-like consolidation, nodules or bronchiectasis and are due to worm cysts.
The pulmonary paragonimiasis tend to mimic post primary tuberculosis. Pulmonary infiltrates in paragonimiasis are poorly defined consolidation that changes rapidly with time, whereas infiltrates in tuberculosis are nodular lesions that change slowly. Cyst in paragonimiasis has a smooth inner margin and a thin wall.
After treatment, residual fibrosis and emphysematous change are absent, whereas these findings are usual in tuberculosis. Subpleural inner opacities are unusual in tuberculosis. Residual pleural fibrosis in unusual in paragonimiasis, whereas it is usual in tuberculosis.
The patient who lived in island had the past history taking raw crab and showed blood eosinophilia(52%) and ELISA positive for Paragonimus westermani.
- References
- Im JG, et al. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR 1992;159:39-43
- Keywords
- Lung, Pleura, Infection, Parasitic infection,