대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 502 Date 2007-06-11

  • Courtesy of Jin Hur, MD, Byoung Wook Choi, MD, Kyu Ok Choe, MD. / Department of Diagnostic Radiology, Severance Hospital, Yonsei University College of Medicine, Korea
  • Age/Sex 65 / M
  • Chief ComplaintBlood tinged sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pleuropulmonary paragonimiasis
Radiologic Findings
On chest X-ray, single pulmonary nodule involving in LUL..
CT scans at lung window setting show lobulated nodule on LUL with adjacent interlobular septal and pleural thickening.
CT scan at mediastinal window setting shows heterogenous enhancement of the pulmonary nodule on LUL. with focal adjacent pleural thickening.
On fusion PET-CT, increased FDG uptake is seen on LUL, corresponding to the pulmonary nodule. (maximum standardized uptake value = 5.1)
Brief Review
Pleuropulmonary paragonimiasis is a food-borne parasitic disease caused by the lung fluke Paragonimus westermani, which is endemic in Southeast Asia and the Far East. Human infection results from ingestion of raw freshwater crab or crayfish infected with the metacercaria.
P. westermani excyst in the small intestine, and the larvae penetrate the intestinal wall and enter the peritoneal space. Next they penetrate the diaphragm and pleura and enter the lung in 3? weeks, where they mature to adult flukes.
On chest radiographs, 83% of patients had pulmonary lesions (consolidation, cysts, nodule, and linear opacity) and 61% had pleural lesions (pleural effusion, hydropneumothorax, and pleural thickening).
According to Im et al. the characteristic CT features of paragonimiasis were round low-attenuation cystic lesions (5?5 mm) filled with either fluid or gas, within the consolidation. On CT, air-space consolidation was noted in 82% (14/17), nodules in 41% (7/17), linear opacities extending from the pleura to the lung in 41% (7/17), and bronchiectasis in 35% (6/17). Subpleural linear opacities or a tubular structure communicating with a cyst were suggestive of worm migration tracks.
According to Kim et al. Pleuropulmonary paragonimiasis usually manifests as a subpleural or subfissural nodule of about 2 cm in diameter that frequently contains a necrotic low-attenuation area. The constellation of focal pleural thickening and subpleural linear opacities leading to a necrotic peripheral pulmonary nodule is another frequent CT finding of paragonimiasis. Although minimal and easily overlooked, focal fibrotic pleural thickening adjacent to a pulmonary nodule can be an important clue in the diagnosis of pleuropulmonary paragonimiasis on CT.
According to a case report by Watanabe et al., pulmonary paragonimiasis can mimic lung cancer by showing a high FDG uptake on FDG PET.
References
1. Im JG et al. Pleuropulmonary paragonimiasis: radiologic findings in 71 patients. AJR 1992; 159:39?3.
2. Kim TS et al. Pleuropulmonary paragonimiasis:CT findings in 31 patients AJR 2005; 185:616?21.
3. Watanabe S et al. Pulmonary paragonimiasis mimicking lung cancer on FDG-PET imaging. Anticancer Res 2003;23:3437?440.
Keywords
Lung, Infection, Parasitic infection,

No. of Applicants : 41

▶ Correct Answer : 1/41,  2.4%
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
▶ Semi-Correct Answer : 37/41,  90.2%
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Dept. of Radiodiagnosis and Imaging,PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Nirman diag centre ,Mumbai, India Padma Kannan
  • - IRSA La Rochelle, France Denis Chabassiere
  • - Sctimst trivandrum, kerala, India Santhosh Kannath
  • - Regional Imaging - Riverina, Australia Rashid Hashmi
  • - E-Da hospital, Taiwan Yu-Feng Wei
  • - Ruby Hall Clinic, Pune, India John Joseph
  • - Ondokuz Mayis University, Samsun Turkey Cetin Celenk
  • - KAUMS, Kashan, Iran Ebrahim Razi
  • - Osaka University, Japan Osamu Honda
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Diagnostics, Sunder Lal Jain Hospital, New Delhi, India Sanjeev Kumar Vachher
  • - IRSA LA ROCHELLE, France Jean-Luc BIGOT
  • - Consultant Radiologist and Director, Sadashiv Peth, Pune, India Abhimanyu Kelkar
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Mumbai , India Rahul B Deshmukh
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - NUH, nottingham, UK Rohit Kochhar
  • - University of Colorado Health Sciences Center, Denver, CO, USA Seth Kligerman
  • - Konkuk University, College of Medicine, Korea Jeong Geun Yi
  • - Australia Julie Arora
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Polyclinique de SAVOIE, ANNEMASSE, France GAY-DEPASSIER Philippe
  • - Annecy hospital, France Gilles Genin
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Yongsan Hospital, College of Medicine Chung-Ang University, Korea Jae Seung Seo
  • - Doctors Hospital, Nassau, Bahamas N.B.S.Mani
  • - Vital imaging centre, mumbai, India Ganesh Agrawal
  • - Balabhai Nanavati hospital, mumbai, India Susheel Kumar
  • - CHU NIMES, France Blondel Manuel
  • - Anandnagar, Hingne Khurd, Pune, India Bankim J.Amin
  • - Nuri Karabay
  • - Sotiria Hospital Athens Greece Delaveri kaith
  • - CHU Grenoble, France BING Fabrice
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - CHRU Lille hopital calmette, France Toledano Manuel
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