Tuberc Respir Dis.  2007 Dec;63(6):521-525.

A Case of Paragonimiasis that was Suspicious for a Lung Malignancy by PET/CT

• Moon YR
• Lee YD
• Park SH
• Cho YS
• Na DJ
• Cho YS
• Han MS
• Choi HJ
• Kim DH
• Yang SO
• Kim KH

Abstract

Positron emission tomography/computed tomography (PET/CT) is valuable for the diagnosis of malignancies. However, PET/CT is unable to discriminate exactly between inflammation and a neoplasm. We report a case of a 50-year-old man with pulmonary paragonimiasis that was suspicious for lung cancer, as detected by PET/CT. The use of PET/CT revealed multilobulated consolidation on the right lung and patchy consolidation on the left lung, with increased fluorodeoxyglucose (FDG) uptake. In addition, the left paraaortic lymph node (LN) and peripancreatic LN showed enlargement with increased FDG uptake. Lung cancer with multiple lymph node metastases was suspected from the increased standardized uptake values (SUV >4.5) determined by PET/CT. We performed wedge resection via video-assisted thoracic surgery (VATS) and found Paragonimus westermani eggs in the involved tissues.

Keyword

Paragonimiasis; PET/CT; Lung; VATS

MeSH Terms

Diagnosis
Eggs
Electrons
Humans
Inflammation
Lung Neoplasms
Lung*
Lymph Nodes
Middle Aged
Neoplasm Metastasis
Ovum
Paragonimiasis*
Paragonimus westermani
Positron-Emission Tomography and Computed Tomography*
Thoracic Surgery, Video-Assisted

Figure

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  Figure 1 Chest PA shows both costophrenic angle blunting.

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  Figure 2 Coronal PET maximum intensity projection image (A) shows multiple increased FDG uptake at whole body. Transverse PET image (upper row), transverse CT lung window image (middle row) and transverse PET/CT image (lower row) show multilobulated consolidation, increased FDG uptake at both upper lobe (B), left upper lobe lingular division (C).

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  Figure 3 Transverse PET image (upper row), transverse CT image (middle row) and transverse PET/CT image (lower row) show left paraaortic lymph node (A), peripancreatic lymphode enlargement (B) with increased FDG uptake (SUV: 4.64~5.01) and fat infiltration with FDG uptake (SUV: 5.31) at left buttock area (C).

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  Figure 4 Expectorated sputum after bronchoscopy shows yellowish refractile eggs (H&E stain, ×100) (A), Excised lung shows distorted golden brown eggs (about 65×40µm) in eosinophil-rich exudates (H&E stain, ×400) (B).

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