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  • Several episodes of hematemesis in the last 6 months; cough developed in the last month; occasional labored breathing. No response to azithromycin; negative urine antigen Blastomyces test.
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  • At least 3 nodular lesions in the lungs – with the nodule in the left cranial lobe appearing cavitated are noted on the thoracic radiographs.
  • On the CT images there are multiple cavitated pulmonary lesions, mainly peribronchial. Most of these lesions are thick walled and contain non-enhancing material.
  • Airway sampling revealed neutrophilic and eosinophilic inflammation.
  • Sputum sample confirmed Paragonimus.

Progression of lesions – Paragonimus

Day 10

  • Pleural effusion, subpleural nodules +/- ground-glass opacities, linear opacities.

Day 30

  • Increased subpleural/peribronchial nodules, pleural effusion, pneumothorax, abdominal/chest wall air bubbles, early cavitary changes.

Day 60

  • Increased cavitary changes, mediastinal lymphadenopathy.

After Day 60

  • Bronchial dilation
    • Supleural groundglass opacities and subpleural nodules +/- cavitary cahnges consistently present until day 180.

Lee CH et al. Serial CT Findings of Paragonimus Infested Dogs and the Micro-CT Findings of the Worm Cysts. Korean J Radiol 2007;8:372 – 381.

Sputum sample, 100x magnification.

Sputum sample, 500x magnification.