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Weekly Chest CasesArchive of Old Cases

Case No : 612 Date 2009-07-20

  • Courtesy of Park Mi Jung, Jeon Kyung Nyeo / Gyeongsang National University, College of Medicine
  • Age/Sex 58 / M
  • Chief ComplaintChronic cough for 6 months, Heavy current smoker, Peripheral eosinophilia (12.8%)
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Diagnosis With Brief Discussion

Diagnosis
Pulmonary paragonimiasis
Radiologic Findings
Chest PA shows poorly defined small nodular opacities in LLL field. Contrast enhanced chest CT shows several, irregular, lobulating nodules in BLLs. These nodules are located in subpleural region and diaphragm and some necrotic portions are seen within the nodule. HRCT scan shows some linear strand connecting adjacent nodule and pleura. Also irregular shaped abscess in the Lt perinephric space. The involvement of kidney is very rare.
Brief Review
Human paragonimiasis is caused by the trematode Paragonimus westermani or other Paragonimus species through the ingestion of raw or partially cooked freshwater crabs or crayfish infected with the metacercaria. The main endemic areas are east Asia, Southeast Asia, Latin America (primarily Peru), and Africa (primarily Nigeria). The lung is the target organ. Diagnosis is confirmed by detecting parasite eggs in the sputum, pleural fluid, or feces; in addition, larvae can often be found at bronchial brushing. Intradermal and serologic tests are also available. The penetration of juvenile worms through the diaphragm into the pleural cavity can cause pleural effusion (37%) or pneumothorax (17%). Once the parasites get to the lung, patchy airspace consolidation can occur, the presence of an exudative or hemorrhagic pneumonia which can cavitate. Contrast enhanced CT may show hypoattenuating fluid-filled cysts surrounded by hyperattenuating consolidation in the adjacent lung. Linear areas of increased opacity indicate peripheral atelectasis or worm migration. Worm cysts manifest as either solitary or multiple nodules or gas-filled cysts depending on their content and their communication with the airway.
Please refer to
Case 259, Case 295, Case 349, Case 409, Case 502, Case 527, Case 537, Case 585,
References
Keywords
Lung, Infection, Parasitic infection,

No. of Applicants : 91

▶ Correct Answer : 42/91,  46.2%
  • - Osaka University , Japan Osamu Honda
  • - Seoul National University Bundang Hospital , Korea (South) Kwang Nam Jin
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - , Korea (South) Daekeon Lim
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - hospital Sao Paulo , Brazil israel missrie
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Pusan National University Hospital , Korea (South) YU LI SOL
  • - Ewha Womans University , Korea (South) Eun Ha
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Saga University , Japan Ryoko Egashira
  • - McGill University Health Centre , Canada Amr Ajlan
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Seoul National University Hospital , Korea (South) Hye Jin Yoo
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - CHUV, Lausanne , Switzerland Andrea Ojanguren
  • - Seoul National University Hospital , Korea (South) JUNG KIM
  • - IRSA , France jean-luc BIGOT
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - Toyama University Hospital, Laboratory of Pathology , Japan TANAKA TOMONORI
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - SMC , Korea (South) Jihoon Cha
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chaehun Lim
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Correct Answer as Differential Diagnosis : 7/91,  7.7%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - kims,narkatpally , India k bhaskar
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Semi-Correct Answer : 2/91,  2.2%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
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