Discussion
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
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- Keywords
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