대한흉부영상의학회 Weekly Chest Cases

Case No : 295 Date 2003-06-21

Courtesy of Sung Min Ko, M.D., Joon Beom Seo, M.D. / Asan Medical Center, Seoul, Korea
Age/Sex 52 / M
Chief ComplaintRecurred right pneumothorax

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Diagnosis With Brief Discussion

Diagnosis: Pleuropulmonary Paragonimiasis
Radiologic Findings: Chest PA shows right pneumothorax with apical bullae, patchy infiltrates in right perihilar area and linear and ill-defined small nodular opacities in both lungs.
High-resolution CT scan demonstrates right pneumothorax, multifocal patchy opacities in both lungs, especially subpleural nodular opacities in left upper lobe and linear opacity in right upper lobe and air cyst in right apex.
Brief Review: Paragonimiasis is caused by flukes of the genus Paragonimus and the most frequent etiologic agent is Paragonimus westermani. Humans typically acquire the disease by ingesting raw or undercooked crabs or crayfish or by drinking water contaminated by them. The major target organ is the lung, followed by the brain.
Parasites induce inflammatory infiltrate, sometimes granuloma, and cystic cavities. Symptoms include hemoptysis, pleuritic chest pain, and chronic cough, which may produce sputum containing the ova of the infecting organism. The pulmonary change result from chronic inflammation in areas surrounding the worm.
Radiologic manifestations of pulmonary paragonimiasis vary with the stage of the disease. Early findings include pneumothorax or hydropneumothorax, focal air-space consolidation, and linear opacities 2 to 4 mm thick and 3 to 7cm long extending inward from pleura caused by the migration of juvenile worms. Later findings include thin-walled cysts, dense mass-like consolidation, nodules or bronchiectasis and are due to worm cysts.
The pulmonary paragonimiasis tend to mimic post primary tuberculosis. Pulmonary infiltrates in paragonimiasis are poorly defined consolidation that changes rapidly with time, whereas infiltrates in tuberculosis are nodular lesions that change slowly. Cyst in paragonimiasis has a smooth inner margin and a thin wall.
After treatment, residual fibrosis and emphysematous change are absent, whereas these findings are usual in tuberculosis. Subpleural inner opacities are unusual in tuberculosis. Residual pleural fibrosis in unusual in paragonimiasis, whereas it is usual in tuberculosis.
The patient who lived in island had the past history taking raw crab and showed blood eosinophilia(52%) and ELISA positive for Paragonimus westermani.
References: Im JG, et al. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR 1992;159:39-43
Keywords: Lung, Pleura, Infection, Parasitic infection,

No. of Applicants : 27

▶ Correct Answer : 20/27, 74.1%

- Annecy Hospital, France Gilles Genin
- Armed Forces Seoul Hospital, Korea Chang Min Park
- Bharat Scans, Tamil, Nadu P. Xavier Rajesh
- Chonnam National University Hospital, Korea SeokKyun Chung
- CHU Nancy-Brabois, France Denis Regent
- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- Chung Li Ten-Chen Hospital,Taiwan Yen-Li Chou
- Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
- CIM Saint Dizier, France JC Leclerc
- Dong-A University Hospital, Busan, Korea Ki-Nam Lee
- Ewha Woman's University Mpkdong Hospital Sung Shine Shim
- Geumgang Asan Hospital, Korea Ju Youn Park
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jecheon Public Health Center, Korea Seung Hun Ryu
- Kangbuk Samsung Hospital, Korea Semin Chong
- Kangseo Songdo hospital, Korea Ji Young Yun
- Seoul National University Hospital, Korea Jae-Joon Yim
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
- Upasana Hospital, Kollam, India Joy A Thomas

▶ Semi-Correct Answer : 1/27, 3.7%

- Social Security Hospital, Ankara, Turkey Meric Tuzun

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 295 Date 2003-06-21

Discussion

No. of Applicants : 27