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Weekly Chest CasesArchive of Old Cases

Case No : 1332 Date 2023-05-02

  • Courtesy of Eun Young Kim, Gil Medical Center / Gachon University College of Medicine
  • Age/Sex 61 / M
  • Chief ComplaintCough
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary paragonimiasis
Radiologic Findings
Fig 1. Chest PA shows mass-like consolidation in the left upper lung zone with Lt pleural effusion.
Fig 2-3. Chest CT image reveals cavitary consolidation at LUL apex, and nodular consolidation at RML and RLL, and small amount of pleural effusion at Lt.
Considering the possibility of vasculitis such as granulomatosis with polyangiitis, he underwent VATS wedge resection of RML, and pathology showed necrotizing granulomas with giant cells containing eggs, which can morphologically suggest paragonimus infection. Serum P. Westermani IgE Ab (+) was positive.
Brief Review
Pleuropulmonary paragonimiasis is a parasitic infection caused by lung flukes including Paragonimus westermani. The most common symptoms are intermittent hemoptysis or blood-tinged sputum and cough.
Paragonimiasis usually occurs from the ingestion of raw or improperly cooked freshwater crabs or crayfish. 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 or multiple 1- to 4-cm cystic spaces containing reddish-brown mucinous fluid. When erosion occurs into draining airways, the contents of the cyst may be coughed up or may spread to other portions of the lung parenchyma and the result is exudative or hemorrhagic pneumonia.
Pleural or lung parenchymal lesions are commonly found on CT or chest radiographs, and radiologic manifestations of pleuropulmonary paragonimiasis vary with the stage of the disease. 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. Pleural paragonimiasis manifests as focal pleural thickening, pneumothorax, pleural effusion, hemothorax, and empyema. Focal pleural thickening usually appears adjacent to parenchymal lesions, which can be helpful to diagnose paragonimiasis.
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, Case 1125, Case 1164, Case 1186, Case 1266,
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

No. of Applicants : 89

▶ Correct Answer : 31/89,  34.8%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan KYOKO NAGAI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - , Korea (South) KANGHWI LEE
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Other , Korea (South) CHAEHUN LIM
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Manipal hospital Hebbal, Bengaluru , India PRAVIN KUMAR M
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Korea (South) SONG MYUNG WON
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - , Korea (South) HM PARK
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - , Korea (South) JIN WOO YOON
▶ Correct Answer as Differential Diagnosis : 4/89,  4.5%
  • - Gifu University Hospital , Japan Yo Kaneko
  • - TB centre kasaragod. , India rikhy krishnan
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 2/89,  2.2%
  • - Other , Korea (South) SEONG WON JANG
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
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