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Weekly Chest CasesArchive of Old Cases

Case No : 1021 Date 2017-05-21

  • Courtesy of Joo Sung Sun, MD, Eun Young Kim MD, PhD, Kyung Joo Park MD, PhD / Ajou University School of Medicine
  • Age/Sex 54 / M
  • Chief ComplaintCough for 8 weeks, hemoptysis for 6 weeks.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary paragonimiasis with mediastinal parasitic cysts
Radiologic Findings
Fig 1-2. Lung window setting of chest CT at the level of aortic arch shows irregular pulmonary nodule in RUL anterior segment. Contiguous serpentine linear opacity is noted at anterior aspect of irregular shape pulmonary nodule. Mediastinal setting of the pre- and post-contrast chest CT at the level of left atrium and cardiac base scans rim-enhanced lobulated tubular structures and nodules in the right anterior mediastinum and bilateral cardiophrenic area. There is no obvious calcification of these lesions. Small right pleural effusion is noted.
Figs 3. FDG-PET scan shows mild FDG uptake of this pulmonary and mediastinal lesions (SUVmax 3.2~3.5).
Brief Review
Paragonimiasis is a trematode (fluke) infection transmitted via consumption of raw or undercooked crab or crayfish. Approximately 16 species have been reported to cause disease in humans, the most common of which is the oriental lung fluke, P. westermani. Paragonimiasis can have pulmonary and extrapulmonary manifestations. Extrapulmonary paragonimiasis: Immature flukes can also migrate to extrapulmonary tissues, such as the brain, abdomen, and subcutaneous tissues. Other ectopic localizations such as the heart, mediastinum, striated muscle, spinal cord, parotid gland, testes, and breasts have also been described. Eggs or flukes in ectopic sites can provoke an inflammatory reaction, resulting in cyst, abscess, or granuloma formation. In case of pleuropulmonary paragonimiasis, focal fibrotic pleural thickening adjacent to a pulmonary nodule can be an important clue to the diagnosis of pleuropulmonary paragonimiasis. In addition, subpleural or subfissural nodules, often containing a necrotic low-attenuation area, may be observed on computed tomography (CT),
Of the Paragonimus westermani infestation, mediastinal paragonimiasis is a rare condition because of its life cycle.
References
1. Song KH, Baek MJ, Sun K, Kim KT, Lee IS, Kim HM: Pulmonary hamartoma. Korean J Thorac Cardiovasc Surg. 1993 Jan;26(1):67-69
2. Kim TS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR Am J Roentgenol 2005; 185:616.
Keywords
Pleuropulmonary Paragonimiasis, Mediastinum, Pleura,

No. of Applicants : 90

▶ Correct Answer : 22/90,  24.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Other , Korea (South) SEONG SU KANG
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Busan National University Hospital , Korea (South) KIM JEONG MYEONG
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Samsung medical center , Korea (South) Ran Kim
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Other , Korea (South) HAYEON LEE
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Seoul National University Hospital , Korea (South) YONSUB SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - University of Utah , United States AKIHIKO SAKATA
  • - Pusan national university hospital , Korea (South) So min Park
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
▶ Correct Answer as Differential Diagnosis : 10/90,  11.1%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - , Korea (South) JEONGBIN PARK
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Other , Korea (South) IN CHUL NAM
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