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Weekly Chest CasesArchive of Old Cases

Case No : 537 Date 2008-02-11

  • Courtesy of Yoon Kyung Kim, MD / Ewha Womans University, Mokdong hospital, Seoul, Korea.
  • Age/Sex 36 / F
  • Chief ComplaintBlood tinged sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary paragonimiasis
Radiologic Findings
Chest radiographs show nodular opacity in right upper lobe and left lower lobe. CT scan obtained on 2007-6-11 show a cavitary nodule in anterior segment of RUL and another necrotic nodule in LLL. On follow up images obtained on 2007-9-17, nodules are increased in size with elongated contour. The patient had peripheral blood eosinophilia and PW antibody was positive. Wedge resection of RUL lesion was performed and pathology revealed distorted eggs in granuloma with inflammation and hemorrhage in surrounding lung parenchyma.
Brief Review
Pleuropulmonary paragonimiasis is a food-borne parasitic disease caused by the lung fluke Paragonimus westermani. Human infection results from ingestion of raw freshwater crab or crayfish infected with the metacercaria.
In a study of experimentally induced pulmonary paragonimiasis in cats, the appearance of pulmonary lesions varied with the stage of the infection and the surrounding tissue reaction. Early findings, which were caused by the migration of juvenile worms, included pneumothorax or hydropneumothorax, focal air-space consolidation, and linear opacities. Later findings resulting from worm cysts included thin-walled cysts, masslike consolidation, nodules, or bronchiectasis.
In other study of 31 patients with pargonimiasis, main findings were pulmonary nodules, focal pleural thickening or indentation adjacent to a pulmonary nodule, and area of ground-glass attenuation or bronchiectatic change adjacent to a nodule. Differential count of blood eosinophil was increased in approximately 70% of the patients.
References
1. Im JG, Kong Y, Shin YM, et al. Pulmonary paragonimiasis: clinical and experimental studies. Radiographics 1993; 13:575-586
2. Kim TS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR 2005; 185:616-621
Keywords
Lung, Infection, Parasitic infection,

No. of Applicants : 55

▶ Correct Answer : 7/55,  12.7%
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Hospital Sao Paulo, Brazil Israel Missrie
  • - CHU de Poitiers, France Paul Ardilouze
  • - Annecy Hospital, France Gilles Genin
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - IRSA La Rochelle, France Jean-Luc Bigot
  • - Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
▶ Correct Answer as Differential Diagnosis : 10/55,  18.2%
  • - Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
  • - Shiga University of Medical, Japan Norihisa Nitta
  • - Vitalife Clinics, Pune, India Rahul Deshmukh
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - China Medical University, Taiwan Jun-Jun Yeh
  • - Gimpo Woori Hospital, Korea Son Youl Lee
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - Aims, New Delhi, India Ashish Gupta
▶ Semi-Correct Answer : 34/55,  61.8%
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Ondokuz Mayis University, Samsun Turkey Cetin Celenk
  • - National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
  • - Osaka University, Japan Osamu Honda
  • - Anandnagar, Hingne Khurd, Pune, India Bankim J. Amin
  • - Apollo Hospitals, Bangalore, India Sridhar. A.S
  • - Az. Osped. Santa Maria - Terni, Italy Angelo Carloni
  • - E-Da Hospital, Taiwan Yu-Feng Wei
  • - National Taiwan University Hospital, Taiwan Chi-Hsien Chen
  • - Almana Hospital, Saudi Arabia Jamal Abazid
  • - Dongguk University International Hospital, Korea Hee Seok Choi
  • - Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
  • - Mokpo Hankook Hospital, Korea Sang Uk Park
  • - Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Regional Imaging Riverina, Australia Rashid Hashmi
  • - Soonchunhyang university Bucheon hospital, Korea Min Hee Lee
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - CHU de Nancy, Service de Pneumologie, 54000 Nancy France Abraham Bohadana
  • - Balabhai Nanavati hospital, mumbai, India Susheel Kumar
  • - Pulmonologist, Medical College Chest Hospital, Thrissur, Thrissur, India Raveendran. T.K
  • - Oswal Cancer Hospital, Sherpur Chowk, Ludhiana, Punjab, India Lovkesh Mittal
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Medinova Diagnostics, Bheemavaram, AP, India Harsha Vardhan
  • - EKH-Berlin, Germany Michael Weber
  • - Managing Director, Rohini Scans (P) Ltd. Ambattur Chennai India. Umapathi. Mahesh
  • - CHU Grenoble, France Bing Fabrice
  • - University of Virginia, USA Rachita Khot
  • - CHRU Lille hopital calmette, France Toledano Manuel
  • - Nassau, Bahamas Trupti Dabholkar
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Pittwater Radiology, Australia Julie Arora
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
  • - Saga University, Japan Ryoko Egashira
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