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Weekly Chest CasesArchive of Old Cases

Case No : 1399 Date 2024-08-12

  • Courtesy of Soslmi Lee, Hyewon Choi / Chung-Ang University Hospital
  • Age/Sex 72 / M
  • Chief ComplaintChest PA abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary sparganosis
Radiologic Findings
Fig 1. Chest PA shows 2.7cm nodular opacity in right middle lung zone.
Fig 2-5. Enhance axial CT scans reveal multifocal irregular shaped nodular lesions in both lungs, predominantly in peripheral portion. Largest lesion in RLL has internal multiple necrotic portion and adjacent GGO
Brief Review
Sparganosis is a rare parasitic disease caused by the second-stage larva of Spirometra mansoni. It occurs worldwide, but only a few patients show pulmonary involvement. The main sources of infection are cats, frogs, dogs, and other animals, which are intermediate hosts. Humans, who are also a second-intermediate host and paratenic hosts, can be infected with spargana by drinking water contaminated with procercoid-infected copepods, eating undercooked meat of snakes or frogs infected with spargana, or using poultries of frog or snake flesh or skin on open wounds. The parasites have strong migration and proliferation abilities and can usually pass through the intestinal wall and the peritoneum, finally reaching the subcutaneous tissues.
Sparganosis mansoni are of 5 types : eye sparganosis, subcutaneous sparganosis (m/c), oral and maxillofacial sparganosis, brain sparganosis and visceral sparganosis. Among these, visceral sparganosis is rare, compromising only 1% of all cases. Thus, pulmonary involvement is rarely reported in the literature.
Common clinical symptoms are cough, fever and chest pain. Peripheral blood eosinophilia was found in 75% of patients. Lesions were located in lung parenchyma, airway, pleural and pulmonary vessels of the patients. 1/3 of patients had pleural effusion.
The characteristics of a chest radiograph and CT images are as follows:
- Commonly distributed in the lower part of the lung with patchy GGOs and nodules
- Ground-glass opacity around nodules
- Pleural effusion or hydropneumothorax
In the pulmonary parasite infection, tunnel signs or track sign were reported to be characteristic CT findings of pulmonary paragonimiasis. Also, migrating parasite in pulmonary vessel can be identified.
As an extremely rare and life-threatening parasitic zoonosis, pulmonary sparganosis should be diagnosed by combining the epidemiology, patient history, eosinophilia and the positive antisparganum antibody test result together if no worm was detected. Oral praziquantel is considered to be an effective treatment.
References
1. Cheng K-B, Gao B-L, Liu J-M, Xu J-F. Pulmonary sparganosis mansoni : a case report from a nonendemic region. J Thorac Dis 2014;6(6):E120-E124
2. Oh Y-J, Kim M-J, Cho J-H, Cha, C-W, Kim D-H, Oh M-J, Chin J-Y, Choi S-S, Kwon K-W. A case of pulmonary sparganosis in a patient with a history of recurrent sparganum infections. Tuberc Respir Dis 2009;67:229-233
3. Ning Li, Yi Xiang, Yun Feng, Min Li, Bei Li Gao, Qing Yun Li. Clinical features of pulmonary sparganosis. Am J Med Sci 2015;350(6):436-441.
4. Mitsuru Matsuki, Higashiyama Akira. Pulmonary Sparganosis: Tunnel Sign and Migrating Sign on Computed Tomography. Intern Med 2021; 60:601-604
Keywords

No. of Applicants : 64

▶ Correct Answer as Differential Diagnosis : 2/64,  3.1%
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Mie university , Japan SHIKO OKABE
▶ Semi-Correct Answer : 28/64,  43.8%
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Other , Korea (South) SEONGSU KANG
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - , Korea (South) HEONSEOK LEE
  • - , Korea (South) JIN YOUNG LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Other , Korea (South) SEOL A LEE
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Other , Korea (South) HYEJOO PARK
  • - , Korea (South) DONG-HO BANG
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Japan SHUNJIRO NOGUCHI
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Kyoto University , Japan SHO KOYASU
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - , Japan YOSHIKI ISHII
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - Other , Korea (South) CHAEHUN LIM
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
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