대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 349 Date 2004-07-03

  • Courtesy of Jae Hyuk Lee, M.D., Duk Sik Kang, M.D. / Kyungpook National University Hospital, Dae-gu, Korea
  • Age/Sex 42 / F
  • Chief ComplaintPleuritic chest pain. (unremarkable previous medical history)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pleuropulmonary paragonimiasis
Radiologic Findings
Chest CXR : Bilateral hydropneumothorax

Chest CT : Bilateral hydropneumothorax, subpleural nodular lesions in the left upper lobe
Recurrent bilateral pleural effusion after 4 months.
The patient had a history of having freshwater crab preserved in soy sauce.

Paragonimiasis metacercariae was found in the pleural fluid.
Brief Review
P. westermani gains entrance to its human host as an encysted metacercariae within freshwater crabs and crayfish. Once ingested the larvae escape from the cyst in the small intestine, penetrate the intestinal wall, and enter the peritoneal cavity. In 3-8 weeks, they penetrate the diaphragm and pleura and enter the lung. The larvae mature into adult flukes within the lung, and cystic cavities form around the flukes.
On radiographs, during the process of pleural penetration by juvenile worms, pneumothorax or pleural effusion is seen, and during the process of larval migration within the lung, patch migrating air-space cosolidation appears. The appearance of pulmonary lesions on radiographs varies with the stage of the infection and the surrounding tissue reaction. The initial finding is patchy air-space consolidation due to hemorrhagic pneumonia caused by the migrating worm. At this stage pleural effusion and pneumothorax is frequently seen. As juvenile worms mature into adults, they tend to settle down , and cysts form around them (worm cysts).
On radiographs, peripheral linear shadows 2-4mm thick and 3-7cm long and invariably extending from the pleural surface suggest worm migration tracks or peripheral atelectasis caused by obstruction of small airways by the worm.
On CT scans round low-attenuation cystic lesions (5-15mm), filled either with fluid or air, were characteristically seen within the consolidation. Peripheral linear opacities were suggestive of worm migration tracks on CT scans. Other finding were variable-sized nodules and bronchiectasis.
References
1. JG Im, HY Whang, WS Kim, MC Han, YS Shim, SY Cho. Pleuropulmonary paragonimiasis: radiologic finding on 71 patients Am. J. Roentgenol., Jul 1992; 159:39-43.
2. H. Mukae, H. Taniguchi, N. Matsumoto, H. Tiboshi, J.-i. Ashitani, S. Matsukura, and Y.Nawa Clinicoradiologic Features of Pleuropulmonary Paragonimiasis westermani on Kyusyu Island, Japan Chest, August 1, 2001; 120(2): 514 - 520
Keywords
Lung, Pleura, Infection, Parasitic infection,

No. of Applicants : 39

▶ Correct Answer : 25/39,  64.1%
  • - Aditya Imaging, Baroda, India Vivek Patel
  • - Air force education & training command Hospital, Korea Hyukwon Chang
  • - Annecy Hospital, France Gilles Genin
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Busan Veterans Hospital, Korea Suhku Huh
  • - CHU Nancy-Brabois, France Denis Regent
  • - Chungnam national university hospital, Korea Mihyun Park
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Eulji hospital, Korea Jeong Joo Woo
  • - Ewha Woman's University Hospital, Korea Yoo Kyoung Kim
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Hanyang University Hospital, Seoul, Korea Mi-Jeong Jang
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Jecheon Hyundae Hospital, Korea Ryu Seung Hun
  • - Jikei University Hospital, Tokyo Japan Shigeki Misumi
  • - Kangbuk Samsung Hospital, Korea Hyon Joo Kwag
  • - Kangnam St. Mary's Hospital, Korea Hyun-Jin Park
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Pohang hospital, Korea Jae hyoung Park
  • - Samsung Medical Center, Korea Semin Chong
  • - Samsung Medical Center, Korea Sung Shine Shim
  • - Seoul National University Hospital, Korea Ho Yun Lee
  • - Seoul National University Hospital, Korea Heesun Park
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
▶ Semi-Correct Answer : 7/39,  17.9%
  • - Calmette, Lille, France Delhaye D
  • - CHU Grenoble, France Mathieu Rodiere
  • - CIM Saint Dizier, France JC Leclerc
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Mubarak Hospital, Kuwait Varghese Sajeev PJ
  • - National Taiwan University Hospital, Taiwan Tan Che Kim
  • - Samsung Medical Center, Korea Yon Mi Sung
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