Epidemiology
- Endemic in Asia
Physiology
- Ingestion of undercooked or wine-soaked fresh water crustaceans -> excysts in human intestine and fluke penetrates wall -> swims freely in peritoneal cavity -> penetrates diaphragm into pleural space (causing eosinophilic pleural reaction) -> penetration of visceral pleura, causing a parenchymal inflammation (hemoptysis( -> encapsulation by imflammation (forms a fibrotic lung nodule)
Diagnosis
CXR/Chest CT Pattern:
1) Pleural effusion: may be an isolated finding on CXR
2) Lung nodule: well-defined 3-4 cm nodule (may be an isolated finding on CXR)/ lower-lobe predominance/ occasional calcification/ cavitation is common/ multiple ring opacities or thin-walled cysts are characteristic
- Pleural fluid:
- Appearance: yellow, non-turbid
- pH: low
- LDH ratio: elevated
- Total protein ratio:
- Glucose: decreased
- Cell count/ diff: neutrophil-predominant with eosinophilia
Clinical Presentations
- Transitory/ self-limited GI complaints (during GI and peritoneal phase): nausea/ bloating/ epigastric pain/ watery diarrhea
- Hemoptysis/ cough/ dyspnea/ chest pain (during lung phase):
- Lung Nodule (see [[Lung Nodule or Mass]])
- Pleural Effusion (see [[Pleural Effusion-Exudate]]
Treatment
- Praziquantel: prevents late hemoptysis and pulmonary complications
References
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