PubMed · 5241687
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V Moseley. 1968. Human dirofilariasis.. https://pubmed.ncbi.nlm.nih.gov/5241687/
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We present a case of human pulmonary dirofilariasis, diagnosed in a 55-year-old heavy smoker (male) by wedge resection of the pulmonary lesion and histologic examination. The dirofilaria lesion had the clinical and radiographic appearance of a peripheral pulmonary lesion invading the anterior chest wall and mediastinum. The reported radiographic image of the disease is different from the usually described picture of a pulmonary coin lesion.
Pulmonary dirofilariasis is a rare entity caused by Dirofilaria, a dog worm that is transmitted to humans by mosquitoes. The filarial nematode enters the subcutaneous tissue, travels to the right ventricle, dies and then embolizes the pulmonary vessels causing a small pulmonary infarction, which subsequently appears as a solitary nodule. Although these nodules are usually identified incidentally by chest radiography in asymptomatic patients, the lesion is generally presumed to be neoplastic. Diagnosis is made by surgical excision. Awareness of this benign entity is important in the differential diagnosis of pulmonary coin-lesions.
Pulmonary dirofilariasis (PD), caused by Dirofilaria immitis (D. immitis), the dog heartworm, is not common in humans, though we recently encountered 4 cases. Chest X-ray images from annual health examinations showed a single spherical nodule in the inferior or middle portion of the right lung in each patient. None of the patients showed any clinical symptoms and had no contact with dogs. Hematological results in 3 of the cases were within normal limits, while mild eosinophilia was found in one. Serological tests for the Anti-Dirofilaria antibodies were not performed. There were no characteristic clinical manifestation of PD in any of the patients, however, we consider it important to keep a diagnosis of PD in mind, when we experienced these cases, they present no characteristic clinical manifestations. Pathologically, macroscopic findings showed well-circumscribed nodules that were round peripheral lesions in lungs. Histological results revealed coagulation necrosis with fibrosis and granulation in the nodule edge, which contained inflammatory cells. By means of silver staining, the worm structures in the nodules could be identified well, and the quadrant cells in the sections were numbered about 30. Immunohistochemically, the somatic muscle tissues were stained with anti-Dirofilaria antibody. These findings indicated that the pulmonary lesions in all 4 cases were due to D. immitis.