CTICasesParagonimiasis (Lung Fluke)
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Imaging findings
A solitary lung nodule is present, with a subtle 'worm track' extending into an area of nodular consolidation. Associated findings include an unexplained right pleural effusion, intense lymphadenopathy (diaphragmatic and internal mammary), pericardial thickening, and inflammation within the omentum.
Key takeaways
Paragonimiasis can manifest with a variety of chest findings, including solitary lung nodules that may demonstrate a 'worm track,' chronic pleural effusions, intense lymphadenopathy (including internal mammary and diaphragmatic nodes), pericardial thickening, and peritoneal inflammation. Extrapulmonary dissemination can occur, leading to renal involvement or embolic stroke. A history of consuming raw crawfish (e.g., in the Ozarks for *Paragonimus calicotti*) is a common exposure. Unexplained eosinophilia and pleural effusion should always prompt consideration of paragonimiasis.
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