Korean J Gastroenterol.  2015 Jul;66(1):41-45. 10.4166/kjg.2015.66.1.41.

A Case of Intra-abdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration

• Oh CR
• Kim MJ
• Lee KH

• KMID: 2373310
• DOI: http://doi.org/10.4166/kjg.2015.66.1.41

Abstract

Paragonimiasis has been continuously decreasing in Korea. However, it still occurs by ingesting raw or incompletely cooked fresh water crab or crayfish. The diagnosis of paragonimiasis is challenging because of its rarity. It may be confused with other inflammatory disease or carcinomatosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has lower risk of complications such as bleeding, perforation than percutaneous fine needle aspiration. EUS-FNA is more accurate and popular method to find mucosal or submucosal tumors and the lesions of several organs. Benign and malignant tumors, infectious diseases have been diagnosed by EUS-FNA, but there was no report describing the use of EUS-FNA for diagnosing paragonimiasis. Herein, we present a 47-year-old male patient with paragonimiasis diagnosed by EUS-FNA. Imaging studies revealed mass lesions in the lung and peritoneal cavity, which was eventually confirmed as paragonimiasis using EUS-FNA.

Keyword

Paragonimiasis; Endoscopic ultrasound-guided fine needle aspiration

MeSH Terms

Endoscopic Ultrasound-Guided Fine Needle Aspiration
Enzyme-Linked Immunosorbent Assay
Humans
Lung Neoplasms/pathology
Male
Middle Aged
Paragonimiasis/*diagnosis/diagnostic imaging/immunology
Positron-Emission Tomography
Tomography, X-Ray Computed

Figure

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  Fig. 1. CT scans of chest and abdomen at admission. (A) At medial basal segment of right lower lobe, there is a 4.0 cm sized soft tissue density mass (arrow) harboring multifocal low attenuation areas. (B, C) On upper abdomen, there are three soft tissue density masses containing multiple necrotic low attenuation areas of bunch-of-grapes shape. A 3.5 cm sized mass (black arrow) is observed at right peri-renal space, a 4.5 cm sized mass (white arrowhead) at greater curvature side of stomach lower body along gastroepipoloic vessel, and a 4.6 cm sized mass (white arrow) at portocaval space.

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  Fig. 2. PET scan images. (A) PET scan reveals an ovoid nodular opacity (arrow) with mild F-18 fluorodeoxyglucose (FDG) uptake in the right lower lobe of lung (maximal standardized uptake value [SUV] 3.2). (B-D) PET scan reveals three low attenuation lesions (arrows) with increased FDG uptakes in the portocaval space, gastroepiploic area and right peri-renal space (maximal SUV 5.1).

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  Fig. 3. Endoscopic ultrasonography-guided fine needle aspiration findings. (A) On portocaval space, there was a heterogeneous hypoechoic 3 cm sized cystic mass with much debris. (B) After fine needle aspiration, muddy colored pus was obtained.

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  Fig. 4. Eggs of Paragonimus wester-mani obtained by endoscopic ultra-sonography-guided fine needle aspiration from tissue (A) and pus (B). The eggs are ovoid, with a thick shell and often asymmetrical with one end slightly flattened (H&E stain, ×400).

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  Fig. 5. Follow-up CT scans of chest and abdomen. (A-D) Fifteen months later after chemotherapy, chest and abdomen CT scans reveal much decreased mass lesions (black and white arrows and arrowhead).

Reference

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