대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1164 Date 2020-02-17

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  • Courtesy of Kyung Eun Shin / SoonChunHyang University Hospital, Bucheon
  • Age/Sex 57 / M
  • Chief ComplaintLeft chest wall discomfort 3 days ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Paragonimiasis
Radiologic Findings
Fig 1. Chest CT shows subpleural consolidation in the left lower lobe.
Fig 2(a-b). Chest CT scans after 3 months show decreased consolidation and another new subpleural consolidation with focal air bubbles in the left lower lobe.
Fig 3. Follow-up chest CT after 5 months shows improvement of subpleural consolidation and newly appeared thin-walled tubular cavitary lesions in the left lower lobe.

Serum P. Westermani IgE Ab was positive.
Brief Review
Pulmonary paragonimiasis is a food-borne parasitic disease caused by the lung fluke Paragonimus westermani, which is endemic in Southeast Asia and the Far East. The most common symptoms are intermittent hemoptysis or blood-tinged sputum and cough. After ingested by humans, Paragonimus excyst in the small intestine, and the larvae penetrate through intestinal wall to gain access to the peritoneal cavity. Several weeks later, the organism travels through the diaphragm on its way to the pleural space. Next they enter the lung, where they mature to adult flukes and produce cysts that contain eggs. Paragonimiasis typically results in single of multiple 1- to 4-cm cystic spaces containing reddish brown mucinous fluid. When erosion occurs into a draining airways, the contents of the cyst may be coughed up or may spread to other portions of the lung parenchyma and result is exudative or hemorrhagic pneumonia.

The imaging manifestations of disease parallel to the life cycle of the parasites. The characteristic CT features of pulmonary paragonimiasis are round low attenuation cystic lesions filled with fluid or gas. CT scan also showed air-space consolidation, nodules, worm migration track, and bronchiectasis. The prevalence of pleural effusion varies.
Please refer to
Case 259, Case 295, Case 349, Case 409, Case 502, Case 527, Case 537, Case 585, Case 612, Case 676, Case 684, Case 715, Case 741, Case 828, Case 885, Case 909, Case 965, Case 1021, Case 1029, Case 1075, Case 1113, Case 1125,
KSTR Imaging Conference 2004 Spring  Case 7 ,
KSTR Imaging Conference 2005 Spring  Case 5 ,
KSTR Imaging conference 2009 Summer  Case 12 ,
KSTR imaging conference cases 2010 Sprng  Case 4 ,
KSTR Imaging conference 2010 Summer  Case 6 ,
KSTR Imaging Conference 2014 Spring  Case 1 ,
KSTR imaging conference 2017 Summer  Case 5,
References
1. Kim TS et al. Pleuropulmonary Paragonimiasis: CT Findings in 31 Pateints. AJR 2005; 185: 816-821
2. Henry TS et al. Chest CT Features of North American Paragonimiasis. AJR 2012; 198: 1078-1083
3. KN Jeon, MJ Park, KS Bae, HY Choi, HC Choi, JB Na, et al. J Korean Soc Radiol 2013;69:365-371
Keywords
lung, parasite , paragonimiasis,

No. of Applicants : 76

▶ Correct Answer : 62/76,  81.6%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Kyeongpook National University Hospital , Korea (South) CHANGGUN KIM
  • - , Korea (South) CHOHEE KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Korea (South) DAJUNG KIM
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Inje University Pusan Paik Hospital , Korea (South) DA SOM KIM
  • - , Korea (South) JIN YOUNG LEE
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - University of Michigan , United States GABIN YUN
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - , Korea (South) JU WON LEE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - , Korea (South) HYUNJIN KIM
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Other , Korea (South) JIN YOUNG KIM
  • - Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Hallym University Dongtan Medical Center , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Okayama University Hospital , Japan SOICHIRO OKAMOTO
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kitano hospital , Japan SATOSHI IKEDA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Samsung Changwon Hospital , Korea (South) DONG SU KIM
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - Chonnam National University Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul National University Hospital , Korea (South) SEUNG JIN YOO
  • - Asan Medical Center , Korea (South) HYEMIN AHN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 2/76,  2.6%
  • - Other , Korea (South) HONG SANG HYUP
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
▶ Semi-Correct Answer : 1/76,  1.3%
  • - Ondokuz Mayis University , Turkey CETIN CELENK
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