RESUMEN
OBJECTIVE: In this study, we examined the value of chest CT signs combined with peripheral blood eosinophil percentage in differentiating between pulmonary paragonimiasis and tuberculous pleurisy in children. METHODS: Patients with pulmonary paragonimiasis and tuberculous pleurisy were retrospectively enrolled from January 2019 to April 2023 at the Kunming Third People's Hospital and Lincang People's Hospital. There were 69 patients with pulmonary paragonimiasis (paragonimiasis group) and 89 patients with tuberculous pleurisy (tuberculosis group). Clinical symptoms, chest CT imaging findings, and laboratory test results were analyzed. Using binary logistic regression, an imaging model of CT signs and a combined model of CT signs and eosinophils were developed to calculate and compare the differential diagnostic performance of the two models. RESULTS: CT signs were used to establish the imaging model, and the receiver operating characteristic (ROC) curve was plotted. The area under the curve (AUC) was 0.856 (95% CI: 0.799-0.913), the sensitivity was 66.7%, and the specificity was 88.9%. The combined model was established using the CT signs and eosinophil percentage, and the ROC was plotted. The AUC curve was 0.950 (95% CI: 0.919-0.980), the sensitivity was 89.9%, and the specificity was 90.1%. The differential diagnostic efficiency of the combined model was higher than that of the imaging model, and the difference in AUC was statistically significant. CONCLUSION: The combined model has a higher differential diagnosis efficiency than the imaging model in the differentiation of pulmonary paragonimiasis and tuberculous pleurisy in children. The presence of a tunnel sign on chest CT, the absence of pulmonary nodules, and an elevated percentage of peripheral blood eosinophils are indicative of pulmonary paragonimiasis in children.
Asunto(s)
Eosinófilos , Paragonimiasis , Tomografía Computarizada por Rayos X , Tuberculosis Pleural , Humanos , Paragonimiasis/diagnóstico , Paragonimiasis/diagnóstico por imagen , Masculino , Femenino , Niño , Estudios Retrospectivos , Diagnóstico Diferencial , Tuberculosis Pleural/diagnóstico , Preescolar , Adolescente , Curva ROC , Sensibilidad y EspecificidadRESUMEN
ABSTRACT: A few pediatric cases of abdominal paragonimiasis have been described. Here we describe a case of pulmonary and abdominal paragonimiasis with involvement of the pancreas in a 9-year-old boy. The aim of this study was to analyze the clinical and radiological features of pancreatic paragonimiasis in children and raise the awareness of this disease.
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Paragonimiasis , Masculino , Humanos , Niño , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/tratamiento farmacológico , Pulmón , Radiografía , Páncreas/diagnóstico por imagenRESUMEN
ABSTRACT: A 32-year-old man underwent 18 F-FDG PET/CT to evaluate suspicious hepatic metastases, which were revealed by ultrasonography and MRI. The FDG PET/CT images demonstrated only one focus of subtly increased activity in the liver without abnormality elsewhere. The pathological result from hepatic biopsy was consistent with Paragonimus westermani infection.
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Paragonimiasis , Humanos , Masculino , Adulto , Paragonimiasis/diagnóstico por imagen , Hígado/diagnóstico por imagen , Hígado/parasitología , Hígado/fisiología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Imagen por Resonancia Magnética , UltrasonografíaRESUMEN
PURPOSE: The purpose of this study was to investigate which findings were delayed in diagnosis with respect to chest CT findings of paragonimiasis. METHODS: This retrospective, informed questionnaire study was conducted to evaluate chest CT scans of 103 patients (58 men and 45 women; mean age 46.1 ± 14.6 years). The patients were diagnosed with paragonimiasis from 2003 to 2008 in four tertiary hospitals. Statistical analysis was performed using the chi-square test to identify differences between an initially correct diagnosis and an incorrect one of paragonimiasis on chest CT scans, for which we evaluated such variables as the location of lesion, type of parenchymal lesions, and worm migration track. RESULTS: Nodular opacities on chest CT scans were the most common findings (53/94, 56.4%). The sign of worm migration tracks was only present in 18.1% of cases (17/94). Although statistically insignificant, the form of consolidation (18/25, 72%) and mass (6/8, 75%) on CT was common in correct diagnostics, and the form of the worm migration track (12/17, 70.6%) was high in correct diagnostics. CONCLUSION: A delayed diagnosis of paragonimiasis may often be made in patients with non-nodular, parenchymal lesions who are negative for worm migration track on chest CT scans.
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Enfermedades Pulmonares Parasitarias , Paragonimiasis , Femenino , Humanos , Enfermedades Pulmonares Parasitarias/diagnóstico por imagen , Paragonimiasis/diagnóstico por imagen , Estudios Retrospectivos , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos XRESUMEN
Pulmonary paragonimiasis can occasionally induce bilateral pneumothorax and cause lesions in ectopic organs such as the liver. We report the case of a 26-year-old man who had been treated for bilateral hydropneumothorax one month earlier and returned to the emergency center complaining of epigastric pain that had persisted for four months. After being diagnosed with pulmonary and hepatic paragonimiasis, he was treated with praziquantel and his condition improved without complications.
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Paragonimiasis , Neumotórax , Adulto , Humanos , Hígado/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Masculino , Paragonimiasis/diagnóstico , Paragonimiasis/diagnóstico por imagen , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/terapia , Resultado del TratamientoRESUMEN
Paragonimiasis is a disease caused by parasitic infections that mainly involve the lungs. However, it can also produce ectopic infections, such as when the parasites invade the liver, brain and subcutaneous tissue, which then cause different symptoms. This current case report describes a 55-year-old male patient with hepatic paragonimiasis that was misdiagnosed as liver cancer with rupture and haemorrhage. The initial computed tomography findings suggested ruptured liver cancer. The patient underwent laparoscopic right hemihepatectomy. Postoperative pathological analysis resulted in a diagnosis of hepatic paragonimiasis. The patient recovered well postoperatively and was treated with 25 mg/kg praziquantel orally three times a day for 3 days after discharge with good efficacy. In this present case, the rupture and haemorrhage of the liver mass made it difficult for the treating physicians to consider hepatic paragonimiasis, which lead to the initial misdiagnosis of this patient. Although paragonimiasis is very rare, medical staff should be vigilant and have a comprehensive understanding of the different diseases that can cause liver masses so that misdiagnosis can be avoided.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Paragonimiasis , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/diagnóstico por imagen , Errores Diagnósticos , Hemorragia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Paragonimiasis/diagnóstico , Paragonimiasis/diagnóstico por imagenRESUMEN
OBJECTIVES: Paragonimiasis is a global foodborne zoonosis. Overlapping clinical and imaging features with other lung pathologies hamper correct diagnosis and require differential diagnosis. METHODS: During 1982-2003, 49,012 samples were referred for immunodiagnosis of helminthiases. We detected paragonimiasis cases by enzyme-linked immunosorbent assay (ELISA). We assessed clinical, radiographical and laboratory characteristics, and diagnostic dilemmas associated with delayed diagnosis. RESULTS: We analyzed 685 pleuropulmonary paragonimiasis cases. ELISA-positive was 665. Eggs were detected in 50. Symptom duration correlated well with the appearance of chest radiographs; 359 pleural, 33 pleuroparenchymal, and 264 parenchymal lesions (P < 0.001). Twenty-nine had normal chest images. Eosinophilia, seen in 304, was common in pleural and pleuroparenchymal patients (P < 0.05). Chest pain and dyspnea were characteristic for pleurisy patients. Sputum (odds ratios [OR]: 6.79; 95% CI: 4.41-10.47), blood-tinged sputum (OR: 5.62; 95% CI: 3.75-8.42), and foul-odor (OR: 2.70; 95% CI: 1.42-5.16) were significant in parenchymal patients. Delayed diagnosis (119) for ≥ 25 weeks was attributed mainly to misdiagnosis as tuberculosis, malignancy, or chronic obstructive pulmonary disease (COPD) (OR: 111.75; 95% CI: 43.25-288.74). CONCLUSIONS: Variable symptoms and radiographs of pleuropulmonary paragonimiasis depended on the stage of infection. Suspicion of tuberculosis, malignancy, or COPD was major cause of delayed diagnosis.
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Eosinofilia , Paragonimiasis , Tuberculosis , Humanos , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/epidemiología , Pleura , EsputoRESUMEN
AIM: To investigate the clinical manifestations and radiologic characteristics in diagnosing and treating hemorrhagic cerebral paragonimiasis. MATERIAL AND METHODS: The study retrospectively analyzed the data of three cases of hemorrhagic paragonimiasis who received treatment in the hospital from January 2014 to March 2017. All three patients were diagnosed with paragonimiasis by positive detection of paragonimiasis antibody. Based on the imaging data, the disease was confirmed as hemorrhagic cerebral paragonimiasis. One of the three patients was treated with oral praziquantel alone, one with praziquantel and thoracentesis, and one with praziquantel in combination with closed thoracic drainage and craniotomy. RESULTS: All the lesions disappeared after computed tomography scan during the follow-up. Two of the three patients had no dysneuria, and one had mild dysneuria. CONCLUSION: Hemorrhagic cerebral paragonimiasis should be diagnosed as early as possible using antibodies against paragonimiasis for patients with unexplained intracerebral hemorrhage, especially young patients with atypical imaging findings and multiple systemic lesions. It is possible to avoid craniotomy and improve the cure rate by the early, full-dose, and sufficient course of anti-parasitic treatment.
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Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/terapia , Craneotomía/métodos , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/terapia , Praziquantel/uso terapéutico , Hemorragia Cerebral/etiología , Niño , Terapia Combinada/métodos , Humanos , Masculino , Paragonimiasis/complicaciones , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Intraspinal paragonimiasis is a rare entity for which imaging findings have seldom been described. The present study investigated the MR imaging features of spinal paragonimiasis, thus providing diagnostic imaging evidence and exploring the possible pathogenesis of intraspinal paragonimiasis. MATERIALS AND METHODS: The clinical and imaging findings of spinal paragonimiasis in 6 children were analyzed retrospectively. Spinal MR imaging was performed in all patients, 5 of whom also underwent enhanced MR imaging. The diagnosis was confirmed by enzyme-linked immunosorbent assay in all cases and postoperative pathology in 4 cases. RESULTS: All cases manifested as fusiform-shaped or beanlike masses in the extradural space in the thoracic spine. The extradural masses were connected with pleural lesions through the intervertebral foramen. The plain MR imaging scan showed mixed signals with predominant isointensity on T1WI and hyperintensity on T2WI, among which 5 (5/6) masses presented as patchy hemorrhage with hyperintensity on T1WI. On enhanced scans, all masses (5/5) showed heterogeneous marked enhancement, with thickening and enhancement in the adjacent spinal meninges (5/5). Various degrees of spinal cord compression and edema were found in 5 cases (5/6). CONCLUSIONS: MR imaging is sensitive for detecting and characterizing spinal paragonimiasis. The MR imaging features of intraspinal granulomas included localization to the extradural space and thoracic segment, connections between intraspinal lesions and pleural lesions through the intervertebral foramen, and hemorrhagic foci within the mass. These findings support an intraspinal mode of paragonimiasis pathogenesis: The Paragonimus larvae migrate from the chest into the extradural space through the intervertebral foramen.
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Imagen por Resonancia Magnética/métodos , Paragonimiasis/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Niño , Femenino , Granuloma/diagnóstico por imagen , Granuloma/etiología , Granuloma/patología , Humanos , Masculino , Paragonimiasis/patología , Estudios Retrospectivos , Enfermedades de la Columna Vertebral/patología , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: To analyze the clinical manifestations and imaging characteristics of pulmonary and extra pulmonary paragonimiasis westermani. METHODS: A retrospective analysis was performed of 30 patients diagnosed by clinical features, laboratory serological tests and surgical pathology. RESULTS: The symptoms of the lung included mainly chest distress, fever, chest pain, cough and expectoration, and dyspnea. The extra pulmonary symptoms included abdominal pain, vomiting, diarrhea, poor appetite, emaciation, both lower extremities asthenia, headache, dizziness, epileptic seizures, and subcutaneous migratory masses. The laboratory examination showed that the eosinophil numbers of serum and pleural effusion of all the thirty patients were increased, and the eggs of Paragonimus westermani were found by the stool tests in four cases. The chest CT tests found abnormal nodules, ground glass changes, insect damages, pleural effusion, "tunnel" signs, and "halo" signs. Cranial CT and MRI showed intracranial hemorrhage foci, and extensive "finger-like" edema. Abdominal CT showed serpentine deformation and "tunnel" signs in the hepatic and spleen capsules. CONCLUSIONS: Paragonimiasis westermani is a multiple organ system involved infection, and it has complex and varied clinical manifestations. The "tunnel" sign and serpentine deformations in the intracranial part, lung, liver and spleen are important imaging manifestations of the disease.
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Paragonimiasis , Paragonimus westermani , Tomografía Computarizada por Rayos X , Animales , Heces/parasitología , Humanos , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/patología , Derrame Pleural , Estudios RetrospectivosAsunto(s)
Dolor en el Pecho/parasitología , Enfermedades Pulmonares Parasitarias/diagnóstico , Paragonimiasis/diagnóstico , Adulto , Dolor en el Pecho/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Síndrome Hipereosinofílico/parasitología , Pulmón/diagnóstico por imagen , Pulmón/parasitología , Enfermedades Pulmonares Parasitarias/diagnóstico por imagen , Enfermedades Pulmonares Parasitarias/parasitología , Masculino , Paragonimiasis/diagnóstico por imagen , Pleuresia/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagenAsunto(s)
Líquido del Lavado Bronquioalveolar/parasitología , Enfermedades Pulmonares Parasitarias/diagnóstico por imagen , Paragonimiasis/diagnóstico por imagen , Paragonimus westermani/aislamiento & purificación , Animales , Femenino , Humanos , Persona de Mediana Edad , Óvulo , Tomografía Computarizada por Rayos XAsunto(s)
Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/tratamiento farmacológico , Paragonimus westermani/aislamiento & purificación , Praziquantel/uso terapéutico , Adulto , Animales , China , Humanos , Masculino , Resultado del TratamientoRESUMEN
We report a case of Paragonimus westermani infection simultaneously affecting two separate organs that presented as both a pulmonary cavity and adrenal mass in an immunocompromised host. A 65-year-old male with a previous kidney transplant visited our clinic because of hemoptysis. Chest computed tomography (CT) showed a pulmonary cavity and right adrenal gland mass. The Aspergillus antigen titer in bronchial lavage fluid was elevated and showed positive conversion. It was necessary to differentiate lung cancer with adrenal gland metastasis from a fungal infection with an adrenal gland adenoma. Positron emission tomography CT suggested benign disease, and it was misdiagnosed as pulmonary aspergillosis based on the elevated Aspergillus antigen titer in the bronchial lavage fluid. Owing to the adverse effects of anti-fungal treatment, the patient underwent wedge resection of the lung and P. westermani was confirmed. A careful history revealed that the patient had eaten raw freshwater crabs 3 years earlier, and a test for serum antibodies to P. westermani was positive. Despite treatment with praziquantel, the adrenal mass persisted on 3-month follow-up CT. A right adrenalectomy was performed and a P. westermani infection was confirmed.
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Enfermedades de las Glándulas Suprarrenales , Enfermedades Pulmonares , Paragonimiasis , Paragonimus westermani , Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Enfermedades de las Glándulas Suprarrenales/cirugía , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/parasitología , Glándulas Suprarrenales/cirugía , Anciano , Animales , Diagnóstico Diferencial , Enfermedades Transmitidas por los Alimentos/diagnóstico por imagen , Enfermedades Transmitidas por los Alimentos/cirugía , Humanos , Pulmón/diagnóstico por imagen , Pulmón/parasitología , Pulmón/cirugía , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/cirugía , Masculino , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/cirugía , Radiografía Torácica , Tomografía Computarizada por Rayos XAsunto(s)
Paragonimiasis/complicaciones , Enfermedades Vasculares de la Médula Espinal/complicaciones , Animales , Anticuerpos/sangre , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Paragonimiasis/diagnóstico por imagen , Paragonimus/inmunología , Paragonimus/patogenicidad , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagenRESUMEN
Paragonimiasis is a parasitic lung infection caused by lung flukes of the genus Paragonimus. Ectopic infection may occur but rarely involves the liver. Here, we report a case of hepatic paragonimiasis in a Chinese man who was initially suspected to have hepatocellular carcinoma. He had been previously diagnosed with chronic hepatitis B. No specific symptoms or abnormal blood test results were observed, except for a significant rise in serum alfa-fetoprotein. Magnetic resonance imaging revealed a 12-cm mass with inhomogeneous signal intensity at the left lobe of the liver. Laparoscopic left hemihepatectomy was performed. He was finally diagnosed as hepatic paragonimiasis upon pathological examination and antibody serology. The postoperative course was uneventful. He received a standard course of praziquantel and recovered well. Our case is unique in its tumor-like characteristic and protrudes the difficulty of differential diagnosis with both benignant and malignant hepatic diseases by imaging studies or non-specific symptoms. Hepatic paragonimiasis is unusual; however, it should be considered in the differential diagnosis of liver malignancy by clinicians.
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Carcinoma Hepatocelular/diagnóstico , Parasitosis Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico , Paragonimiasis/diagnóstico por imagen , Adulto , Animales , Antihelmínticos/uso terapéutico , Diagnóstico Diferencial , Hepatectomía/métodos , Hepatitis B Crónica/diagnóstico , Humanos , Laparoscopía , Parasitosis Hepáticas/tratamiento farmacológico , Parasitosis Hepáticas/cirugía , Imagen por Resonancia Magnética , Masculino , Paragonimiasis/tratamiento farmacológico , Paragonimiasis/cirugía , Praziquantel/uso terapéuticoRESUMEN
Archaeoparasitological studies on fossilized feces obtained from Joseon Dynasty (1392-1910 CE) mummies have provided invaluable data on the patterns of parasitic infection in pre-modern Korean societies. In our recent radiological investigation of a 17th century Joseon mummy discovered in Cheongdo (South Korea), we located a liver mass just below the diaphragm. Anatomical dissection confirmed the presence of a mass of unknown etiology. A subsequent parasitological examination of a sample of the mass revealed a large number of ancient Paragonimus sp. eggs, making the current report the first archaeoparasitological case of liver abscess caused by ectopic paragonimiasis.
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Momias/parasitología , Paragonimiasis/historia , Animales , Autopsia , Historia del Siglo XVII , Humanos , Corea (Geográfico) , Hígado/diagnóstico por imagen , Hígado/parasitología , Hígado/patología , Masculino , Persona de Mediana Edad , Paragonimiasis/diagnóstico por imagen , Paragonimiasis/patología , Paragonimus/aislamiento & purificación , República de Corea , Tomografía Computarizada por Rayos XRESUMEN
Surgical resection is traditionally the preferred treatment for fluorodeoxyglucose-avid peripheral pulmonary nodules that grow over time. However, new technologies, including electromagnetic navigational bronchoscopy (ENB), provide an opportunity to confirm or possibly exclude a cytologic cancer diagnosis, before resection. We present a case of a 56-year-old North American man who presented with a fluorodeoxyglucose-avid pulmonary nodule and sought a second opinion after being recommended thoracotomy with lobectomy. The peripheral nodule was biopsied using ENB and pathologic evaluation of the lesion demonstrated parasitic eggs with features of Paragonimus westermani. No evidence of malignancy was found. The radiographic abnormalities resolved after treatment with praziquantel. Using a minimally invasive procedure with ENB, we successfully diagnosed pulmonary infection with P. westermani, a rare infectious cause of peripheral pulmonary lesions in a patient without travel to an endemic area. Furthermore, an alternative diagnosis to cancer was established, sparing this patient an unnecessary thoracotomy with right middle lobectomy.