PMC3350157_01
Chest radiograph shows dumbbell-shaped nodule (arrow) in right lung base.
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fig1
A 48-year-old woman was found to have an incidental right lung nodule on a routine chest radiograph (Figure 1).
Axial contrast-enhanced CT scan shows irregular 2.5 cm solid irregular nodule with slightly heterogeneously low attenuation without significant enhancement. Note partly broad pleural attachment with adjacent pleural thickening and extrapleural fat thickening.
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fig2
CT scan of the thorax confirmed the presence of a right lower lobe posterior basal segment nodule (Figures 2 and 3).
CT scan at lung window setting shows subpleural nodule with pleural tags and partly spiculate margin. Note panlobular emphysema in adjacent area.
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fig3
CT scan of the thorax confirmed the presence of a right lower lobe posterior basal segment nodule (Figures 2 and 3).
Photomicrograph of H&E stained pathologic specimen from wedge resection of lung shows histologic changes compatible with organizing pneumonia. Note a small subpleural cavitary lesion (arrow) and a dilated small bronchus filled with necrotic materials (arrowhead).
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fig4
On histopathology, peripheral organizing pneumonia by paragonimiasis and coexistent small subpleural aspergilloma was noted (Figure 4).
(a) The dilated bronchus is filled with necrotic materials and scattered parasitic eggs (arrows) (H&E, x100). (b) Scattered degenerated parasitic eggs (arrow) morphologically consistent with ova of Paragonimus westermani, intra-alveolar macrophages, and some infiltrating eosinophils (arrowheads) are noted in organizing pneumonia area (H&E, x200).
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fig5
The dilated peripheral bronchus and terminal bronchiole were filled with necrotic material and scattered degenerated parasitic eggs (Figure 5).
The subpleural cavitary lesion is filled with fungus ball, and the surrounding stroma shows fibrosis and foreign body reaction (H&E, x100). These fungal hyphae are highlighted on Gomori methenamine silver stain (lower right, x200) and are morphologically compatible with aspergillus species.
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fig6
In the peripheral portion of the organizing pneumonia, small subpleural intracavitary aspergilloma was also combined (Figure 6).