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Weekly Chest CasesArchive of Old Cases

Case No : 1514 Date 2026-10-26

  • Courtesy of Minseon Kim, Sowon Jang / Bundang Seoul National University Hospital
  • Age/Sex 73 / F
  • Chief ComplaintRecurrent hemoptysis for 2–3 years.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Paragonimiasis
Radiologic Findings
Figs 1-4. Chest CT shows focal bronchiectasis in the posterobasal segment of the right lower lobe with surrounding irregular consolidation and focal cavitary change.
Brief Review
Paragonimiasis is a parasitic infection caused by trematodes of the genus Paragonimus, most commonly Paragonimus westermani, which is endemic in East Asia. Humans are infected by ingestion of raw or undercooked freshwater crabs or crayfish containing metacercariae.
Pulmonary involvement occurs after migration of juvenile worms through the pleura into the lung parenchyma. CT findings are variable and depend on the stage of infection. Early findings include subpleural or subfissural consolidation, linear opacities extending to the pleura, focal pleural thickening, and pneumothorax or hydropneumothorax. Later stages may demonstrate cystic lesions, bronchiectasis, or mass-like consolidation.
Because imaging findings often overlap with pulmonary tuberculosis, malignancy, or fungal infection, diagnosis may be delayed. A characteristic feature is a waxing and waning consolidative lesion, particularly in patients with chronic respiratory symptoms such as hemoptysis. Definitive diagnosis is achieved by identification of parasitic eggs in tissue or body fluids. Treatment with praziquantel is effective in most cases.
References
1. Kim TS, Han J, Shim SS, Jeon K, Koh WJ, Lee I, Lee KS, Kwon OJ. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR Am J Roentgenol. 2005 Sep;185(3):616-21. doi: 10.2214/ajr.185.3.01850616. PMID: 16120908.
2. Henry TS, Lane MA, Weil GJ, Bailey TC, Bhalla S. Chest CT features of North American paragonimiasis. AJR Am J Roentgenol. 2012 May;198(5):1076-83. doi: 10.2214/AJR.11.7530. Erratum in: AJR Am J Roentgenol. 2013 Nov;201(5):1165. PMID: 22528896; PMCID: PMC3832351.
Keywords

No. of Applicants : 78

▶ Correct Answer : 43/78,  55.1%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROKI SAKURADA
  • - , Japan AKIO FUJII
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - , Korea (South) DONG HEE LEE
  • - Other , Korea (South) BYUK GYUNG CHOI
  • - Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
  • - Other , Korea (South) SEONGSU KANG
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Osaka University , Japan AKINORI HATA
  • - Chiba University Hospital , Japan HIROKI MIYAZAKI
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - , Korea (South) JIEUN KIM
  • - Otsu Red Cross Hospital , Japan JUN YOSHIDA
  • - , Japan SHINYA SAHARA
  • - , Korea (South) MINSUN KOO
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) OHMIN KWON
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - , Japan KEIICHIRO YAMADA
  • - Other , Korea (South) CHAEHUN LIM
  • - , Korea (South) HEONSEOK LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - GOP Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , Japan YUKA ONISHI
  • - , Japan TOMOHIRO KAWAJI
  • - Chonnam National University Hospital , Korea (South) SEUNGYOON CHAE
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kobe Children , Japan SHUHEI NORIMOTO
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Dae Jin Medical Center , Korea (South) LEE HYE IN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - , Korea (South) JIYUN KIM
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 6/78,  7.7%
  • - Teikyo University Hospital, Mizonokuchi , Japan TOSHIHIRO FURUTA
  • - , Japan RYOTA INAI
  • - TB centre kasaragod. , India rikhy krishnan
  • - Ehime University , Japan TOMOHISA OKADA
  • - Ehime University , Japan KOTARO MATSUMOTO
  • - University of Yamanashi , Japan KOJIRO ONOHARA
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