대한흉부영상의학회 Weekly Chest Cases

Case No : 1266 Date 2022-01-25

Courtesy of Se Ri Kang, Ji Young Rho / Wonkwang University Hospital
Age/Sex 53 / M
Chief ComplaintIncidental abnormal finding

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Figure 4

Diagnosis With Brief Discussion

Diagnosis: Paragonimiasis
Radiologic Findings: Fig 1. Chest PA shows consolidation in right middle lung field with ipsilateral CP angle blunting.
Fig 2-4. CT scans reveal heterogeneously enhancing subpleural consolidation with internal low attenuated portion in right middle lobe.
Brief Review: The patient underwent a CT-guided lung biopsy and the lesion was pathologically confirmed as paragonimiasis.
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. Pleural or lung parenchymal lesions are commonly found on CT or chest radiographs, and radiologic manifestations of pleuropulmonary paragonimiasis vary with the stage of the disease.
Pulmonary paragonimiasis manifests as focal air-space consolidation, ground-glass opacities in the early stage, which may show the change in location on follow-up CT. When the parasite sac communicates with the bronchus, it appears as a cavitary lesion; On the other hand, if the parasite sac does not communicate with the bronchus, it appears as air-space consolidation or nodule with an internal low attenuated portion. When the peripheral or subpleural consolidation or nodule shows an internal low attenuated portion, it can be helpful to diagnose paragonimiasis, such as in our case. In addition, linear opacity elongated from the pleura can be a helpful diagnostic clue. In the later stage, thin-walled cyst or bronchiectasis can be observed.
Pleural paragonimiasis manifests as focal pleural thickening, pneumothorax, pleural effusion, hemothorax, and empyema. Focal pleural thickening usually appears adjacent to parenchymal lesions, which can be helpful to diagnose paragonimiasis.
Although the symptoms and signs of pleuropulmonary paragonimiasis are nonspecific, an early diagnosis can be made if radiologists understand the pathogenesis and typical imaging findings of the disease.
References: 1. Jeon KN, Park MJ, Bae KS, et al. Paragonimiasis: a pictorial essay. J Korean Soc Radiol 2013;69(5):365-371.
Please refer to: Case 1125 Case 1113 Case 1075 Case 1029 Case 1021 Case 965 Case 909 Case 828 Case 684 Case 612 Case 585 Case 537 Case 502 Case 409 Case 349 Case 295 Case 259
Keywords

No. of Applicants : 91

▶ Correct Answer : 21/91, 23.1%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan JUN KANZAWA
- Mayo Clinic , United States AKITOSHI INOUE
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- , Japan CHIAKI SATO
- Other , Korea (South) HWANGHEE JO
- Other , Korea (South) SEONGSU KANG
- Scans world , India PHILSON JOSEPH MUKKADA
- Osaka University , Japan AKINORI HATA
- Kaneda hospital , Japan HIROFUMI MIFUNE
- Shimada General Medical Center , Japan HAYATO NOZAWA
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Intermed Hospital , Mongolia KHULAN KHURELSUKH
- Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
- Other , Korea (South) KYU-CHONG LEE
- Kyoto University Hospital , Japan SATOSHI IKEDA
- Paras hospital, Panchkula , India SHALEEN RANA
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- , Japan YUKI HAYASHI
- , Korea (South) HM PARK
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 6/91, 6.6%

- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Other , Korea (South) MINSU KIM
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1266 Date 2022-01-25

Discussion

No. of Applicants : 91