Imaging

Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.

The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.

Rick Robbins, M.D. Rick Robbins, M.D.

Medical Image of the Week: Ascaris Lumbricoides

Figure 1. 23 cm adult Ascaris lumbricodes recovered from patient's feces.

A 25 year-old man was admitted to the ICU with acute renal failure and acute respiratory failure from fluid overload after attempting to cross the border. The patient was successfully extubated after five days of mechanical ventilation and renal replacement therapy. Following extubation, the patient had a bowel movement and passed a 23cm adult Ascaris lumbricoides. He was treated with a single dose of albendazole 400 mg.

Ascariasis is a very common helminthic infection, particularly in pediatric populations, and affects mostly the gastrointestinal tract. When infective eggs are swallowed by the host, larvae hatch in the GI tract. The larvae invade the GI mucosa and then are brought into the lungs via portal circulation. The larvae can then move up the tracheobronchial tree and then are swallowed into the GI tract where the mature worms form (1).

While our patient had a simple gastrointestinal infection, several pulmonary complications of ascariasis have been reported (2). Adult worms can cause largyngospasm as well as mechanical obstruction of the airway which can result in cardiac arrest (3,4). This migration of worms from the stomach to the trachea may be related to the use of anesthetics and the subsequent relaxation of the lower esophageal sphincter. Ascaris larvae have been implicated in Loeffler’s syndrome, also described as simple pulmonary eosinophilia, characterized by transient pulmonary infiltrates and eosinophilia with a usually benign course.

Candy Wong1; Aaron Fernandes2, Jennifer Huang2, and Sachin Chaudhary1

1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine.

2 Department of Medicine

University of Arizona

Tucson, AZ

References

  1. Centers for Disease Control and Prevention. Parasites – Ascariasis. Biology. Available at: http://www.cdc.gov/parasites/ascariasis/biology.html (accessed 1/13/2015).
  2. Li QY, Zhao DH, Qu HY, Zhou CN. Life-threatening complications of ascariasis in trauma patients: a review of the literature. World J Emerg Med. 2014;5(3):165-70. [CrossRef] [PubMed]
  3. Maletin M, Veselinović I, Stojiljkovic GB, Vapa D, Budakov B. Death due to an unrecognized ascariasis infestation: two medicolegal autopsy cases. Am J Forensic Med Pathol. 2009;30(3):292-4. [CrossRef] [PubMed]
  4. Husain SJ, Zubairi AB, Sultan N, Beg MA, Mehraj V. Recurrent episodes of upper airway blockage associated with Ascaris lumbricoides causing cardiopulmonary arrest in a young patient. BMJ Case Rep. 2009;2009. pii: bcr01.2009.1415. [CrossRef] [PubMed]

Reference as: Wong C, Fernandes A, Huang J, Chaudhary S. Medical image of the week: ascaris lumbridoies. Souhtwest J Pulm Crit Care. 2015;10(2):81-2. doi: http://dx.doi.org/10.13175/swjpcc008-15 PDF

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