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Pleuropulmonary Paragonimiasis: CT Findings in 31 Patients

Tae Sung Kim1, Joungho Han2, Sung Shine Shim1, Kyeongman Jeon3, Won-Jung Koh3, Inho Lee1, Kyung Soo Lee1 and O Jung Kwon3

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea.
2 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.



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  		Fig. 1A —45-year-old man with pleuropulmonary paragonimiasis. Axial contrast-enhanced CT scan (5-mm collimation) at mediastinal window setting shows 30-mm mass in right upper lobe. Although mass seems to be located centrally, it is not associated with lobar bronchus but shows subpleural and subfissural location. Note area of low attenuation (15 H) (arrow) and enhancing portion (80 H) (arrowhead) of mass.

 


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  		Fig. 1B —45-year-old man with pleuropulmonary paragonimiasis. CT scan at lung window setting shows subpleural and subfissural location of tumor. Note thickening of minor interlobar fissure (arrows) and mediastinal pleura (arrowhead).

 


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  		Fig. 1C —45-year-old man with pleuropulmonary paragonimiasis. Positive tumor uptake (maximum standardized uptake value, 8.1) is seen on FDG PET.

 


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  		Fig. 1D —45-year-old man with pleuropulmonary paragonimiasis. Photomicrograph of pathologic specimen from wedge resection shows granulomatous and fibrous reaction. Intratumoral low-attenuation (15 H) area on contrast-enhanced CT scan (A) is correlated with multiple granulomas (arrows) with central necrosis on histopathologic specimen. Enhancing portion (80 H) of nodule on CT corresponded to organizing pneumonia (asterisk) with granulation tissue and lymphoid follicles. Note fibrotic pleural thickening (arrowheads) with some areas of lymphocytic infiltration. (H and E, x2)

 


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  		Fig. 1E —45-year-old man with pleuropulmonary paragonimiasis. High-power photomicrograph shows multiple eggs (=100 x 50 µm) (arrowheads) of Paragonimus westermani in wall of granuloma. Note multiple eosinophils (arrows) in wall of granuloma and central necrotic portion (asterisk). (H and E, x200)

 


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  		Fig. 2A —60-year-old man with pleuropulmonary paragonimiasis. Axial thin-section CT scan (1-mm collimation) at mediastinal window setting shows 5.5-cm mass (asterisk) in right lower lobe. Note 1-cm, poorly defined subpleural nodule (arrow) in right middle lobe with adjacent mediastinal pleural thickening (arrowheads).

 


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  		Fig. 2B —60-year-old man with pleuropulmonary paragonimiasis. CT scan at lung window setting shows small subpleural nodule (arrow) with adjacent bronchiectasis in right middle lobe. Note mass (asterisk) in right lower lobe, which proved to be squamous cell carcinoma after bilobectomy of right middle and lower lobes.

 


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  		Fig. 2C —60-year-old man with pleuropulmonary paragonimiasis. Photomicrograph of surgical specimen shows subpleural granuloma (arrows) in right middle lobe consisting of fibrotic wall and central necrotic cavity. Note adjacent fibrotic pleural thickening (arrowheads) and bronchiectasis (asterisks). (H and E, x2)

 


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  		Fig. 2D —60-year-old man with pleuropulmonary paragonimiasis. High-power photomicrograph shows multiple eggs (arrows) of Paragonimus westermani lining inner surface of fibrotic wall (asterisk) of granuloma. (H and E, x200)

 


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  		Fig. 3A —43-year-old woman with pleuropulmonary paragonimiasis. Axial contrast-enhanced CT scan (5-mm collimation) at mediastinal window setting shows 3-cm subpleural mass in right upper lobe. Note adjacent focal pleural thickening (arrow).

 


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  		Fig. 3B —43-year-old woman with pleuropulmonary paragonimiasis. CT scan at lung window setting shows poorly defined subpleural mass with adjacent areas of ground-glass attenuation.

 


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  		Fig. 4A —44-year-old man with pleuropulmonary paragonimiasis. CT scan (5-mm collimation) at lung window setting shows 3-cm, poorly defined subpleural nodule with pleural effusion in lingular division of left upper lobe. Note central cavitation and surrounding halo of ground-glass attenuation.

 


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  		Fig. 4B —44-year-old man with pleuropulmonary paragonimiasis. CT scan obtained 4 months after A shows diffuse thickening of pleura (arrowheads) and extrapleural fat (arrows).

 


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  		Fig. 5 —19-year-old woman with pleuropulmonary paragonimiasis. Axial thin-section CT scan (1-mm collimation) at lung window setting shows two cavitary nodules clustered in right upper lobe. Note focal thickening or indentation of adjacent pleura (arrowhead) and short, subpleural linear opacity (arrow) connecting pleura and peripheral nodules, which suggests worm migration track.

 


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  		Fig. 6A —42-year-old woman with pleuropulmonary paragonimiasis. Axial contrast-enhanced CT scan (5-mm collimation) at mediastinal window setting shows two subpleural masses in right upper lobe, one of which shows cavitation (arrowhead). Note thickening of adjacent pleura (arrows).

 


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  		Fig. 6B —42-year-old woman with pleuropulmonary paragonimiasis. Lung window image shows 7-mm-thick, peripheral tubular structure (arrow) that suggests worm migration track (burrow track).

 

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