Chest
Volume 102, Issue 3, September 1992, Pages 851-855
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Clinical Investigations
Pulmonary Dirofilariasis: The Largest Single-Hospital Experience

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Pulmonary dirofilariasis caused by Dirofilaria immitis, the dog heartworm, is a rarely reported pulmonary lesion. It most often appears as a solitary pulmonary nodule, often mistaken for a primary or metastatic lung tumor, and the diagnosis is not often established until thoracotomy with excisional lung biopsy is performed. Sporadic reports of pulmonary dirofilariasis in the United States total only 87 cases. The ten resections of pulmonary dirofilariasis at the Methodist Hospital in Houston, Tex, represent the largest reported series of cases originating at a single hospital. We present an overview of the pathogenesis of this disease, its clinical manifestations and epidemiologic features. The prevalence of pulmonary dirofilariasis appears to be increasing. Thus, surgeons and pathologists need to be aware of this etiology of granulomatous pulmonary lesions.

Section snippets

Case 1

A 48-year-old woman, who is a nonsmoker, was referred to our hospital in August 1989 for evaluation of a 0.8-cm smooth, well-circumscribed, noncalcified nodule in the right middle lobe found on a routine chest x-ray film. The patient was totally free of symptoms.

Case 2

A 67-year-old man, who is a smoker, underwent routine physical examination in August 1989. He had had coronary artery bypass surgery eight years earlier. A chest x-ray film showed a smooth 1-cm noncalcified lesion in the left upper

Discussion

The first report of a human infection from Dirofilaria was in 1887 when de Magalhaes reported finding one male and one female worm in the left ventricle of a male child from Rio de Janeiro, Brazil, as reported by Robinson et al.2 Subsequently in the United States, Dirofilaria was identified in the pulmonary artery in 19403 and in a pulmonary infarction in 1961.4 Since that time, 87 cases from the United States have been recorded in the literature (Fig 1). In no instance have microfilariae been

ACKNOWLEDGMENT

Special acknowledgment is made to Dr. Dina Mody for her help in preparation of the pathology slides, to Dr. Alpert, pathologist, for her help in retrieving cases of dirofilariasis, and to Dr. Thomas Alexander of Tyler, Tex, for graciously supplying the original chest x-ray film for one of our patients, as well as to Natale McDaniels and Magdalena Price from the Pathology Department, and to Barbara Perry for her invaluable secretarial assistance.

Special acknowledgment also is made to the

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