CTICasesParagonimiasis (Lung Fluke)
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Imaging findings
Initial imaging shows a large chronic right pleural effusion with circumferential pleural thickening and inflammatory stranding in the omentum. Subsequent studies reveal cardiophrenic and internal mammary lymphadenopathy, pericarditis, and nodular foci of consolidation abutting fissures or pleural surfaces. Characteristic 'worm tracks' are observed extending into the right upper lobe, and later a spiky Loffler flap is noted.
Key takeaways
Paragonimiasis, or lung fluke infection, is acquired by ingesting raw or undercooked crustaceans. The larvae penetrate the small bowel wall, migrate through the peritoneal cavity into the chest, and can affect the lungs, pleura, pericardium, and peritoneum. Imaging findings are diverse and include chronic pleural effusions, pleural thickening, inflammation in the omentum, pericarditis, and parenchymal nodules with pathognomonic migratory 'worm tracks.' Chronic eosinophilia is a crucial clinical indicator. This patient, originally from Mexico, likely had *Paragonimus mexicanus*.
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