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Moon, Lee, Park, Cho, Na, Cho, Han, Choi, Kim, Yang, and Kim: A Case of Paragonimiasis that was Suspicious for a Lung Malignancy by PET/CT
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(6): 521-525.

Published online: 31 December 2007

DOI: https://doi.org/10.4046/trd.2007.63.6.521

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

You Ri Moon, M.D.1, Yang Deok Lee, M.D.1, Sang Hyun Park, M.D.1, Yong Soo Cho, M.D.1, Dong Jib Na, M.D.1, Yong Seon Cho, M.D.1, Min Soo Han, M.D.1, Hee Jeong Choi, M.D.2, Do Hyung Kim, M.D.3, Seoung Oh Yang, M.D.4, Kyung Hee Kim, M.D.5

1Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea.

2Department of Family Medicine, Eulji University School of Medicine, Daejeon, Korea.

3Department of Thoracic Surgery, Eulji University School of Medicine, Daejeon, Korea.

4Department of Radiology, Eulji University School of Medicine, Daejeon, Korea.

5Department of Pathology, Eulji University School of Medicine, Daejeon, Korea.

Address for correspondence: Yang Deok Lee, M.D., Ph.D. Department of Internal Medicine, Eulji University Hospital, 1306, Dunsan-dong, Seo-gu, Daejeon 302-799, Korea. Phone: 82-42-611-3154, Fax: 82-42-259-1111, lydmd@hanmail.net

Received 31 August 2007       Accepted 29 September 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Paragonimiasis, PET/CT, Lung, VATS

Figures and Tables

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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