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Weekly Chest CasesArchive of Old Cases

Case No : 741 Date 2012-01-09

  • Courtesy of Kwang-nam Jin / SNU-SMG Boramae Medical Center
  • Age/Sex 59 / M
  • Chief ComplaintCough and blood tinged sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Paragonimiasis
Radiologic Findings
CT images show irregular cavitary consolidation and surrounding GGO in the RUL. There is small right pleural effusion. The patient had peripheral blood eosinophilia and positive result of PW antibody. Plain radiography reveals that the nodular opacity in the right upper lung zone decreases in size after medical treatment.
Initial plain radiograph shows nodular opacity at the right upper lung zone and right costophrenic angle bulnting, which are resolved after treatement (Fig. 7 and 8). In addition, plain radiograph demonstrates segmental eccentric luminal narrowing at the upper trachea, caused by extrinsic compression of intrathoracic thyroid goiter.
Brief Review
Paragonimiasis is caused by flukes of the genus Paragonimus; the most frequent etiologic agent is Paragonimus westermani through the ingestion of raw or undercooked freshwater crabs or crayfish infected with the metacercaria. The lung is the target organ. The penetration of juvenile worms through the diaphragm into the pleural cavity can cause pleural effusion (37%) or pneumothorax (17%). The most common findings on CT consist of subpleural or subfissural single or multiple nodules 1-4 cm that frequently contain a necrotic low attenuation area or cavitation. There are commonly associated subpleural linear opacities and focal pleural thickening adjacent to a pulmonary nodule. The appearance of pulmonary lesions is influenced by the stage of the infection and the surrounding tissue reaction. Early findings are caused by the migration of juvenile worms and focal airspace consolidation, linear opacities, pleural effusion, pneumothorax, or hydoropneumothorax. Later findings result from worm cysts and include thin walled cysts, mass-like consolidation, nodules, and bronchiectasis. CT also may show a subpleural streaky opacity 2-7 mm thick and 5-60 mm long connecting the pleura and the nodule, which is presumed to be a worm migration track (burrow track). Diagnosis is confirmed by detecting parasite eggs in the sputum, bronchial washing fluid, or lung biopsy specimens or by serologic test, most commonly enzyme-linked immunosorbent assay.
References
1. Im JG, Whang HY, Kim WS, et al. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR 1992;15-:39-43.
2. Im JG, Kong Y, Shin YM, et al. Pulmonary paragonimiasis: clinical and experimental studies. Radiographics 1993; 13:575-586.
3. Kim TS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR 2005; 185:616-621.
4. Martnez S, Restrepo CS, Carrillo JA, et al. Thoracic Manifestations of Tropical Parasitic Infections: A Pictorial Review. RadioGraphics. 2005; 25:135-155.
Keywords
lung, infection, parasitic,

No. of Applicants : 104

▶ Correct Answer : 52/104,  50.0%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Chonnam National University Hwasoon Hospital , Korea (South) You Ri Choi
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Mackay Memorial Hospital, Taipei , Taiwan Sheng-Yeh Shen
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - University of British Columbia , Canada Amr Ajlan
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Catholic medical center , Korea (South) hyuna kim
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - MASAN , Korea (South) Kim Sang Hyeon
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - DongA University hospital , Korea (South) Jiyoung Kang
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Asan medical center , Korea (South) sang young oh
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - Asan medical center , Korea (South) Jong Woo Kim
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Hanyang Medical Center , Korea (South) Ki Yoon
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Cardio Center Pontica , Bulgaria VLADISLAV RUSINOV
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Asan Medical Center, Seoul , Korea (South) Eun-sol Lee
  • - Asan medical center , Korea (South) Yoon mang
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - GRMC (Gajra raja medical college), deptt. of radiodiagnosis gwalior , India SHAILESH GUPTA
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - UWO , Canada S Lee
  • - All India Institute of medical sciences , India Justin Moses
  • - KUMC ansan , Korea (South) kihwan kim
▶ Correct Answer as Differential Diagnosis : 12/104,  11.5%
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - radiologist, aditya imaging centre , India vivek patel
  • - korea university , Korea (South) Hyelarn Lee
  • - McGill University , Canada Ben Smith
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - XiangYa hospital , China Xia Yu
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - CHRU lille , France manuel toledano
  • - University of Iowa , United States Catherine Metz
  • - IRSA , France, Metropolitan BIGOT
  • - Saint Malo , France jean-baptiste Noel
  • - All India Institute of Medical Sciences , India Ashish Gupta
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