A 66-year-old woman who was a non-smoker presented with hemoptysis. She was examined by chest computed tomography (CT), which showed a pyramid-shaped infiltration by pulmonary hemorrhage in S1 of the right upper lobe (Fig. 1). Seven years later, she had a second episode of hemoptysis. Chest CT revealed a 9-mm, well-demarcated, round nodule in S4 of the right middle lobe against a background of interstitial pneumonia (Fig. 2). She was admitted to our hospital for further examination and treatment. Diagnostic sputum cultures showed no findings indicative of a bacterial infection, including TB. Tumor markers, including carcinoembryonic antigen and cytokeratin 19 fragments, were normal. A blood examination showed no evidence of eosinophilia. During 3 months of observation, the mass continued to grow, reaching a size of 11 x 10 x 8 mm. An 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan showed low 18F-FDG uptake by the nodule. The maximum standardized uptake value was 0.94 (Fig. 3). As neither primary lung carcinoma of a particular histological subtype, including mucinous adenocarcinoma, nor a low-grade malignant tumor could be ruled out, a diangnostic wedge resection of the right middle lobe (S4) was performed (Fig. 4). The intraoperative histopathological diagnosis was a benign granuloma without malignant cells. The postoperative histopathological diagnosis was granuloma with pulmonary dirofiliasis (Fig. 5). The patient's postoperative clinical course was good, and she was discharged on postoperative day 6.
Chest computed tomography (CT) images show a pulmonary hemorrhage spreading radially in the right upper lobe.