Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 666-671
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.666
Pleural lump after paragonimiasis treated by thoracoscopy: A case report
Yue Xie, Ya-Rui Luo, Meng Chen, Yi-Min Xie, Chen-Yu Sun, Qiang Chen
Yue Xie, Department of Burns and Plastic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing 400010, China
Ya-Rui Luo, Outpatient Department, Chongqing University Three Gorges Hospital, Chongqing 404000, China
Meng Chen, Yi-Min Xie, Qiang Chen, Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, Chongqing 400010, China
Chen-Yu Sun, Department of Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL 60657, United States
Author contributions: Xie Y and Luo YR contributed equally to this work and reviewed the literature and contributed to manuscript drafting; Chen M and Xie YM are the patient’s surgeons, performed the surgery, and contributed to manuscript drafting; Sun CY was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Cheklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Chen, MD, Doctor, Department of Pediatric Surgery, Chongqing University Three Gorges Hospital, No. 165 Xincheng Road, Wanzhou District, Chongqing 404000, China. cqwzchenqiang@163.com
Received: September 1, 2020
Peer-review started: September 1, 2020
First decision: November 8, 2020
Revised: November 16, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 26, 2021
Processing time: 141 Days and 3.8 Hours
Abstract
BACKGROUND

Paragonimiasis is a parasitic disease that has multiple symptoms, with pulmonary types being common. According to our clinical practices, the pleural effusion of our patients is full of fibrous contents. Drainage, praziquantel, and triclabendazole are recommended for the treatment, but when fibrous contents are contained in pleural effusion, surgical interventions are necessary. However, no related reports have been noted. Herein, we present a case of pulmonary paragonimiasis treated by thoracoscopy.

CASE SUMMARY

A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days. Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani, serological test showed eosinophilia, and moderate left pleural effusion and calcification were detected on computed tomography (CT). She was diagnosed with paragonimiasis, and praziquantel was prescribed. However, radiography showed an egg-sized nodule in the left pleural cavity during follow-up. She was then admitted to our hospital again. The serological results were normal except slight eosinophilia. CT scan displayed a cystic-like node in the lower left pleural cavity. The patient underwent a thoracoscopic mass resection. A mass with a size of 6 cm × 4 cm × 3 cm adhered to the pleura was resected. The pathological examination showed that the mass was composed of non-structured necrotic tissue, indicating a granuloma. The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.

CONCLUSION

This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.

Keywords: Pulmonary paragonimiasis; Paragonimus; Thoracoscopy; Pleural lump; Pleural effusion; Case report

Core Tip: Paragonimiasis is a common parasitic disease in south China. Based on our clinical experience, the pleural effusion of our patients contains abundant scrambled egg-like materials, and it is difficult to drain all the fluid because the fibrous materials can block the drainage tube. Therefore, the fibrous material can lead to fibrous lump formation. However, there have been rare reports about surgical interventions performed on patients with pleural effusion, hence we recommend early intervention in pleural effusion to prevent the development of the chronic stage.