DOI: 10.1148/rg.251045043
Thoracic Manifestations of Tropical Parasitic Infections: A Pictorial Review1
Santiago Martínez, MD2,
C. Santiago Restrepo, MD,
Jorge A. Carrillo, MD,
Sonia L. Betancourt, MD,
Tomás Franquet, MD,
Claudia Varón, MD,
Paulina Ojeda, MD and
Ana Giménez, MD
1 From the Department of Radiology, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia (S.M.); the Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, La (C.S.R.); the Departments of Radiology (J.A.C.) and Pathology (P.O.), Hospital Santa Clara, Bogotá, Colombia; the Department of Radiology, Hospital de la Samaritana, Bogotá, Colombia (S.L.B.); the Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F., A.G.); and the Department of Radiology, Fundación Cardioinfantil, Bogotá, Colombia (C.V.). Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Scientific Assembly. Received March 16, 2004; revision requested April 20 and received June 23; accepted June 23. All authors have no financial relationships to disclose. Address correspondence to S.M. (e-mail: smart4@lsuhsc.edu).
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Figure 1. Diagram illustrates the life cycle of E histolytica.
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Figure 2a. Right-sided amebic pleural empyema and pneumonia in a 43-year-old man with an abscess of the right hepatic lobe. (a) Initial chest radiograph shows pleural effusion and right-sided basal consolidation. (b) Chest CT scan helps confirm pleural involvement and right-sided basal alveolar infiltrates. Trophozoites of E histolytica were obtained at bronchoalveolar lavage.
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Figure 2b. Right-sided amebic pleural empyema and pneumonia in a 43-year-old man with an abscess of the right hepatic lobe. (a) Initial chest radiograph shows pleural effusion and right-sided basal consolidation. (b) Chest CT scan helps confirm pleural involvement and right-sided basal alveolar infiltrates. Trophozoites of E histolytica were obtained at bronchoalveolar lavage.
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Figure 3a. Right-sided amebic pneumonia in a 35-year-old man with a hepatic abscess. (a) Chest radiograph shows elevation of the right hemidiaphragm and right-sided basal consolidation with cavitation. (b) Photograph of the gross specimen demonstrates an irregular cavitary lesion (arrows). Anchovy sauce content and trophozoites of E histolytica (not shown) were found on the lesion wall.
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Figure 3b. Right-sided amebic pneumonia in a 35-year-old man with a hepatic abscess. (a) Chest radiograph shows elevation of the right hemidiaphragm and right-sided basal consolidation with cavitation. (b) Photograph of the gross specimen demonstrates an irregular cavitary lesion (arrows). Anchovy sauce content and trophozoites of E histolytica (not shown) were found on the lesion wall.
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Figure 4a. Amebic pericardial tamponade in a 27-year-old man with an abscess of the left hepatic lobe. The patient presented with pulsus paradoxus, fever, and chills. (a) Chest radiograph shows enlargement of the cardiac silhouette. (b) Chest CT scan shows extensive pericardial effusion that resulted from rupture of a left hepatic lobe abscess (not shown) into the pericardial space.
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Figure 4b. Amebic pericardial tamponade in a 27-year-old man with an abscess of the left hepatic lobe. The patient presented with pulsus paradoxus, fever, and chills. (a) Chest radiograph shows enlargement of the cardiac silhouette. (b) Chest CT scan shows extensive pericardial effusion that resulted from rupture of a left hepatic lobe abscess (not shown) into the pericardial space.
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Figure 5. Diagram illustrates the life cycle of Plasmodium species (P falciparum, P vivax, P ovale, and P malariae). ARDS = adult respiratory distress syndrome.
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Figure 6. Drawing illustrates the geographic distribution of malaria (red dots). The infection is distributed widely in many tropical and subtropical climates. P vivax is the most prevalent worldwide type of malaria. P ovale is especially prevalent in tropical west Africa. Infection with P falciparum has the highest mortality rate.
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Figure 7. ARDS in a 31-year-old man with P falciparum malaria. Chest radiograph demonstrates patchy bilateral areas of increased opacity. P falciparum trophozoites were found in a thick blood smear.
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Figure 8. Diagram illustrates the life cycle of T cruzi.
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Figure 9. Drawing illustrates the geographic distribution of Chagas disease (American trypanosomiasis) (red dots). The disease is endemic to Central and South America. In North America, although the reservoir host (from the Reduviidae family) and the parasite can be found, most cases are related to immigration from endemic areas.
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Figure 10a. Acute Chagas disease in a 17-year-old boy with acute myocarditis. (a) Chest radiograph shows cardiogenic pulmonary edema, which resolved after 72 hours. Two days later, the patient had a sudden episode of arrhythmia and died. (b) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) demonstrates extensive acute myocarditis. Amastigotes of T cruzi were found within a myofiber.
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Figure 10b. Acute Chagas disease in a 17-year-old boy with acute myocarditis. (a) Chest radiograph shows cardiogenic pulmonary edema, which resolved after 72 hours. Two days later, the patient had a sudden episode of arrhythmia and died. (b) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) demonstrates extensive acute myocarditis. Amastigotes of T cruzi were found within a myofiber.
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Figure 11a. Chronic Chagas disease in a 39-year-old man with chronic dilated cardiomyopathy. (a) Chest radiograph shows global cardiomegaly with pulmonary congestion. (b) Photograph of the gross specimen demonstrates dilatation of the cardiac chambers with thickening of the ventricular myocardium. Scale is in centimeters. (c) Low-power photomicrograph (original magnification, x10; Giemsa stain) shows T cruzi amastigotes within a myofiber (arrow).
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Figure 11b. Chronic Chagas disease in a 39-year-old man with chronic dilated cardiomyopathy. (a) Chest radiograph shows global cardiomegaly with pulmonary congestion. (b) Photograph of the gross specimen demonstrates dilatation of the cardiac chambers with thickening of the ventricular myocardium. Scale is in centimeters. (c) Low-power photomicrograph (original magnification, x10; Giemsa stain) shows T cruzi amastigotes within a myofiber (arrow).
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Figure 11c. Chronic Chagas disease in a 39-year-old man with chronic dilated cardiomyopathy. (a) Chest radiograph shows global cardiomegaly with pulmonary congestion. (b) Photograph of the gross specimen demonstrates dilatation of the cardiac chambers with thickening of the ventricular myocardium. Scale is in centimeters. (c) Low-power photomicrograph (original magnification, x10; Giemsa stain) shows T cruzi amastigotes within a myofiber (arrow).
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Figure 12. Chagasic achalasia in a 13-year-old girl with Chagas disease. Barium esophagogram shows diffuse and severe dilatation of the esophagus. Histologic analysis demonstrated T cruzi amastigotes within the esophageal wall.
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Figure 13. Diagram illustrates the life cycle of A lumbricoides.
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Figure 14a. Ascariasis in a 35-year-old man with migratory infiltrates. (a) Chest radiograph shows areas of ground-glass increased opacity in the right lower and middle lobes. (b) High-resolution CT scan shows areas of ground-glass attenuation that correspond to the findings in a. The resolution of radiologic findings 1 week later demonstrated the transient nature of the disease. Larvae and eggs of A lumbricoides were found at bronchoalveolar lavage and in a fecal smear, respectively, during the acute stage.
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Figure 14b. Ascariasis in a 35-year-old man with migratory infiltrates. (a) Chest radiograph shows areas of ground-glass increased opacity in the right lower and middle lobes. (b) High-resolution CT scan shows areas of ground-glass attenuation that correspond to the findings in a. The resolution of radiologic findings 1 week later demonstrated the transient nature of the disease. Larvae and eggs of A lumbricoides were found at bronchoalveolar lavage and in a fecal smear, respectively, during the acute stage.
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Figure 15. Diagram illustrates the life cycle of S stercoralis.
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Figure 16a. Strongyloidiasis in an 18-year-old man with hemoptysis. (a) Chest radiograph demonstrates extensive bilateral patchy areas of consolidation. (b) High-resolution CT scan more clearly delineates the areas of consolidation. Bronchoalveolar lavage revealed larvae of S stercoralis.
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Figure 16b. Strongyloidiasis in an 18-year-old man with hemoptysis. (a) Chest radiograph demonstrates extensive bilateral patchy areas of consolidation. (b) High-resolution CT scan more clearly delineates the areas of consolidation. Bronchoalveolar lavage revealed larvae of S stercoralis.
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Figure 17a. Hyperinfection syndrome and strongyloidiasis in a 63-year-old man with hemoptysis and chronic renal failure who was being treated with corticosteroids. (a) Chest radiograph shows nodular and reticular infiltrates. (b) High-resolution CT scan of the lungs demonstrates areas of ground-glass attenuation and micronodules that display a miliary pattern. (c) Photomicrograph (original magnification, x40; Giemsa stain) obtained after bronchoalveolar lavage shows a larva of S stercoralis (arrow) surrounded by erythrocytes.
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Figure 17b. Hyperinfection syndrome and strongyloidiasis in a 63-year-old man with hemoptysis and chronic renal failure who was being treated with corticosteroids. (a) Chest radiograph shows nodular and reticular infiltrates. (b) High-resolution CT scan of the lungs demonstrates areas of ground-glass attenuation and micronodules that display a miliary pattern. (c) Photomicrograph (original magnification, x40; Giemsa stain) obtained after bronchoalveolar lavage shows a larva of S stercoralis (arrow) surrounded by erythrocytes.
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Figure 17c. Hyperinfection syndrome and strongyloidiasis in a 63-year-old man with hemoptysis and chronic renal failure who was being treated with corticosteroids. (a) Chest radiograph shows nodular and reticular infiltrates. (b) High-resolution CT scan of the lungs demonstrates areas of ground-glass attenuation and micronodules that display a miliary pattern. (c) Photomicrograph (original magnification, x40; Giemsa stain) obtained after bronchoalveolar lavage shows a larva of S stercoralis (arrow) surrounded by erythrocytes.
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Figure 18. Diagram illustrates the life cycle of D immitis.
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Figure 19a. Dirofilariasis in an asymptomatic 14-year-old girl with a solitary pulmonary nodule. (a) Chest radiograph shows a soft-tissue-opacity nodule in the right upper lung. (b) Photomicrograph (original magnification, x40; Masson stain) obtained after surgical resection shows an infarcted peripheral vessel surrounded by necrotic lung tissue. Some remnants of the parasites are present in the lumen (arrows).
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Figure 19b. Dirofilariasis in an asymptomatic 14-year-old girl with a solitary pulmonary nodule. (a) Chest radiograph shows a soft-tissue-opacity nodule in the right upper lung. (b) Photomicrograph (original magnification, x40; Masson stain) obtained after surgical resection shows an infarcted peripheral vessel surrounded by necrotic lung tissue. Some remnants of the parasites are present in the lumen (arrows).
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Figure 20. Diagram illustrates the life cycle of Echinococcus species.
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Figure 21. Drawing illustrates the geographic distribution of hydatid disease from E granulosus (red dots), E multilocularis (black dots), and E vogeli (green dots). E granulosus is the most common of the Echinococcus species.
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Figure 22. Pulmonary hydatid disease from E granulosus in a 43-year-old man. Chest radiograph shows a large cyst in the right lower lung. (Courtesy of Ricardo Videla, MD, Hospital Italiano, Rosario, Argentina.)
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Figure 23a. Pulmonary hydatid disease from E granulosus in a 32-year-old woman. (a) CT scan of the lung shows a hypoattenuating crescent sign (meniscus sign) (arrows). (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) obtained after surgical resection demonstrates the inner germinal layer, to which several daughter protoscolices of E granulosus are attached.
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Figure 23b. Pulmonary hydatid disease from E granulosus in a 32-year-old woman. (a) CT scan of the lung shows a hypoattenuating crescent sign (meniscus sign) (arrows). (b) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) obtained after surgical resection demonstrates the inner germinal layer, to which several daughter protoscolices of E granulosus are attached.
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Figure 24a. Polycystic echinococcosis of the lung from E vogeli in a 25-year-old man. (a) Chest radiograph demonstrates multiple peripheral round areas of soft-tissue opacity. (b) CT scan shows a clearly defined capsule with a relatively hypoattenuating center, a finding that reflects the cystic nature of the lesions. E vogeli was identified at pathologic analysis as the etiologic agent.
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Figure 24b. Polycystic echinococcosis of the lung from E vogeli in a 25-year-old man. (a) Chest radiograph demonstrates multiple peripheral round areas of soft-tissue opacity. (b) CT scan shows a clearly defined capsule with a relatively hypoattenuating center, a finding that reflects the cystic nature of the lesions. E vogeli was identified at pathologic analysis as the etiologic agent.
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Figure 25a. Polycystic echinococcosis of the chest wall from E vogeli in a 13-year-old boy. (a) Chest CT scan shows cystic thickening of the pleura with chest wall involvement. (b) Photograph of the surgically resected gross specimen demonstrates osseous expansion secondary to rib invasion (scale is in centimeters). Histologic analysis revealed E vogeli. (Case courtesy of Humberto Varón, MD, Fundación Cardioinfantil, Bogotá, Colombia, and Susana Onatra, MD, Hospital de la Misericordia, Bogotá, Colombia.)
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Figure 25b. Polycystic echinococcosis of the chest wall from E vogeli in a 13-year-old boy. (a) Chest CT scan shows cystic thickening of the pleura with chest wall involvement. (b) Photograph of the surgically resected gross specimen demonstrates osseous expansion secondary to rib invasion (scale is in centimeters). Histologic analysis revealed E vogeli. (Case courtesy of Humberto Varón, MD, Fundación Cardioinfantil, Bogotá, Colombia, and Susana Onatra, MD, Hospital de la Misericordia, Bogotá, Colombia.)
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Figure 26. Diagram illustrates the life cycle of Schistosoma species.
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Figure 27. Drawing illustrates the geographic distribution of Schistosoma species (red dots).
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Figure 28. Early pulmonary schistosomiasis in a 28-year-old man who had traveled to Mali. Initially, the patient had fever and urticaria, after which he experienced dry cough, predominantly at night. Chest CT scan shows multiple nodular lesions with ill-defined borders in the lower lobes. Histologic analysis revealed S mansoni. (Courtesy of E. Schwartz, MD, Center for Geographical Medicine and Tropical Diseases, and J. Rozenman, MD, Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel.)
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Figure 29. Diagram illustrates the life cycle of Paragonimus species.
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Figure 30. Drawing illustrates the geographic distribution of Paragonimus species (red dots).
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Figure 31a. Pulmonary paragonimiasis in a 35-year-old man. (a) Chest radiograph shows alveolar areas of increased opacity, predominantly in the left lung. (b) CT scan demonstrates bilateral ill-defined areas of consolidation and areas of ground-glass attenuation associated with left pneumothorax. Eggs of P westermani were found at bronchoalveolar lavage.
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Figure 31b. Pulmonary paragonimiasis in a 35-year-old man. (a) Chest radiograph shows alveolar areas of increased opacity, predominantly in the left lung. (b) CT scan demonstrates bilateral ill-defined areas of consolidation and areas of ground-glass attenuation associated with left pneumothorax. Eggs of P westermani were found at bronchoalveolar lavage.
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Figure 32a. Pulmonary paragonimiasis in a 27-year-old man. (a) Chest radiograph shows cavitated areas of increased opacity in the middle lobe and left upper lobe (arrows). (b) CT scan shows a cavitated area of consolidation in the middle lobe and helped confirm the presence of a cavitated nodule in the left upper lobe (not shown). Eggs of P westermani were found at bronchoalveolar lavage.
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Figure 32b. Pulmonary paragonimiasis in a 27-year-old man. (a) Chest radiograph shows cavitated areas of increased opacity in the middle lobe and left upper lobe (arrows). (b) CT scan shows a cavitated area of consolidation in the middle lobe and helped confirm the presence of a cavitated nodule in the left upper lobe (not shown). Eggs of P westermani were found at bronchoalveolar lavage.
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Figure 33a. Pulmonary paragonimiasis in a 43-year-old man. (a) Chest radiograph shows a soft-tissue nodule in the middle lobe (arrows). (b) CT scan more clearly demonstrates the nodule (arrows). Histopathologic analysis performed after surgical resection demonstrated P westermani.
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Figure 33b. Pulmonary paragonimiasis in a 43-year-old man. (a) Chest radiograph shows a soft-tissue nodule in the middle lobe (arrows). (b) CT scan more clearly demonstrates the nodule (arrows). Histopathologic analysis performed after surgical resection demonstrated P westermani.
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Copyright © 2005 by the Radiological Society of North America.
