대한흉부영상의학회 Weekly Chest Cases

Case No : 1186 Date 2020-07-15

Courtesy of Suyon Chang / Seoul St. Mary's Hospital
Age/Sex 54 / M
Chief ComplaintCough, blood-tinged sputum

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Figure 2
Figure 3

Diagnosis With Brief Discussion

Diagnosis: Paragonimiasis
Radiologic Findings: Figure 1. Chest CT shows subpleural consolidation with GGO and satellite fuzzy nodules in anterior segment of right upper lobe. Bronchial wall thickening with mucoid plugging is noted in anterior segmental bronchus of right upper lobe.
Figure 2. Post-contrast-enhanced CT images reveal low-attenuation lesion within the consolidation and right hilar lymph node enlargement.
Figure 3. Follow-up chest CT after 3 weeks shows size increase of the subpleural consolidation.

There was eosinophilia (25.9 %) in the peripheral blood. Percutaneous transthoracic biopsy was done and microscopic examination revealed chronic inflammation with parasite eggs.
Brief Review: Pleuropulmonary paragonimiasis is a parasitic infection caused by lung flukes including Paragonimus westermani. Paragonimiasis usually occurs from ingestion of raw or improperly cooked freshwater crabs or crayfish. Early findings include pneumothorax or hydrothorax, focal air-space consolidation, and linear opacities. Later findings include thin-walled cysts, mass-like consolidation, nodules, or bronchiectasis.
Pleuropulmonary paragonimiasis usually manifests as a subpleural or subfissural nodule of about 2 cm in diameter that frequently contains a necrotic low-attenuation area. Focal pleural thickening and subpleural linear opacities leading to a necrotic peripheral pulmonary nodule is another frequent CT finding of paragonimiasis. Focal fibrotic pleural thickening adjacent to a pulmonary nodule can be an important clue in the diagnosis of pleuropulmonary paragonimiasis on CT.
Please refer to: 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. KimTS, Han J, Shim SS, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. AJR Am J Roentgenol2005; 185: 616
Keywords: lung, parasitic infection, paragonimiasis,

No. of Applicants : 73

▶ Correct Answer : 15/73, 20.5%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- , Japan HIROAKI ARAKAWA
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- CH de la Cote Basque , France PAUL ARDILOUZE
- McGill University Health Center , Canada Alexandre Semionov
- Scans world , India PHILSON JOSEPH MUKKADA
- Yeungnam University Medical Center , Korea (South) JONGSOO PARK
- Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Asan Medical Center , Korea (South) JIHOON KIM
- , Japan HIROAKI ARAKAWA
- Toranomon Hospital , Japan KAORU SUMIDA
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 7/73, 9.6%

- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Fortis hospital , Mohali , India SHALEEN RANA
- Nishida Hospital , Japan SHOJI OKUDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- Private sector , Greece VASILIOS TZILAS

▶ Semi-Correct Answer : 1/73, 1.4%

- Ondokuz Mayis University , Turkey CETIN CELENK

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1186 Date 2020-07-15

Discussion

No. of Applicants : 73