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Weekly Chest CasesArchive of Old Cases

Case No : 1422 Date 2025-01-20

  • Courtesy of Woo Hyeon Lim, Taehee Lee, Hye Soo Cho / Seoul National University Hospital
  • Age/Sex 84 / M
  • Chief ComplaintRadiologic abnormality; History of left lower lobectomy due to lung cancer (squamous cell carcinoma, pT1cN0)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Paragonimiasis
Radiologic Findings
Fig 1. Chest PA reveals a cavitary nodular opacity in the left upper lung zone.
Fig 2. An irregular, thick-walled cavitary lesion accompanied by surrounding ground-glass opacities was initially noted on a chest CT scan taken 4 months ago. An incidental left pararenal nodule was also identified on the same CT scan. Pneumothorax was persistently observed on both CT scans taken 8 and 4 months ago.
Fig 3. The size of the thick-walled cavitary lesion increased over 4 months, accompanied by a concomitant enlargement of the left pararenal nodule. Pneumothorax resolved on the follow-up CT scan.
Fig 4. These lesions demonstrate hypermetabolism on PET/CT (max SUV: LUL lesion, 8.5; left pararenal lesion, 7.7). The patient underwent bronchoscopy, which revealed numerous Paragonimus eggs on bronchial washing cytology. Paragonimus-specific IgG antibody levels were also elevated in peripheral blood. For the left pararenal nodule, a percutaneous biopsy was performed, confirming the presence of Paragonimus eggs in the biopsy specimen.
Brief Review
Pulmonary paragonimiasis is a parasitic disease caused by Paragonimus westermani, which is endemic to Southeast Asia and the Far East. Paragonimiasis typically results from the ingestion of raw freshwater crab or crayfish infected with the metacercaria of Paragonimus. After ingestion, the metacercaria excyst in the small intestine, and the larvae penetrate the intestinal wall, entering the peritoneal cavity. Eventually, they penetrate the diaphragm and pleura, reaching the lungs within 3–8 weeks. In the lungs, they form cysts containing eggs.
The characteristic CT features of paragonimiasis align with its pathogenesis. These features include hypodense cystic lesions or cavitary lesions (usually 5–15 mm), consolidation, nodules, and linear opacities extending from the pleura to the lung. Pleural involvement may present as nodules, pleural thickening, pneumothorax, pleural effusion, or hemothorax in some cases.
Although the symptoms and signs of pulmonary paragonimiasis are nonspecific, early diagnosis can be achieved if radiologists or clinicians maintain a high index of suspicion based on imaging findings.
References
1. KN Jeon, MJ Park, K Bae, HY Choi, HC Choi, JB Na et al. Paragonimiasis: A Pictorial Essay. J Korean Soc Radiol 2013;69(5):365-371
2. TS Kim, J Han, SS Shim, K Jeon, WJ Koh, I Lee et al. Pleuropulmonary Paragonimiasis: CT Findings in 31 Patients. AJR 2005; 185:616–621
Keywords

No. of Applicants : 62

▶ Correct Answer : 29/62,  46.8%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - , Korea (South) JIN YOUNG LEE
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - , Japan KAYANO MASAKI
  • - , Japan KENTARO KOTANI
  • - , Japan MARINO TANIGUCHI
  • - Mie university , Japan SHIKO OKABE
  • - TB centre kasaragod. , India rikhy krishnan
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
▶ Correct Answer as Differential Diagnosis : 6/62,  9.7%
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 2/62,  3.2%
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
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