Mosquitoes feeding on the blood of the definitive host (domesticated dogs, wolves and foxes) transfer the infective stage larvae into the human subcutaneous tissue. The surviving larvae mature into adult worms, migrate to the heart and embolize into one of the branches of the pulmonary artery followed by the sequence of thrombosis, infarction and intense granulomatous inflammation. The lesion Cisplatin purchase appears as a spherical infarct centered on the obstructed artery and thus mostly located at the lung periphery. A predilection for the right lower lobe has been noted [4]. These worms have also been known to infrequently infect other organs of the human

body such as the brain, skin, eye, urinary bladder, portocaval shunt, peritoneal cavity and the testicle [5]. These are however, quite rare. More than half of Dirofilaria infections are asymptomatic. The most important symptoms include cough, chest pain, fevers, eosinophilia and hemoptysis. A case-series from Japan reported

that 67% of patients were asymptomatic [6]. Another case-series reported from the Texas reported 10 cases of which 5 patients were completely asymptomatic, 3 patients had cough and 1 patient each had presented with shortness of breath and hemoptysis respectively [3]. A definitive diagnosis of dirofilariasis could be achieved by tissue biopsy for histopathology and molecular testing (PCR) [7] and [8]. Wedge biopsy has the highest yield Nintedanib chemical structure but Fine Needle Aspiration Cytology (FNAC) has been GPCR Compound Library high throughput reported to be of diagnostic value in one case report [9]. The disease should be considered as a differential diagnosis

in any patient coming from an area known to be endemic for canine dirofilariasis [3]. Suspicion is stronger in those with a single lung nodule less than 3 cm in size, who are asymptomatic or have minimal symptoms [10]. The differential diagnosis of such nodules includes wide range of malignancies, infections as well as immunological disorders. Systemic eosinophilia is relatively uncommon; only 17% in the Japanese series were noted to have eosinophilia [6]. Serological studies have poor sensitivity (50%) in detecting antibodies to D. immitis because of cross reactivity with other nonfilarial parasites [6], [11] and [12]. Inhabitants of endemic areas can have anti D. immitis antibodies through years of exposure to larval antigens without getting the disease or even through cross reactivity to other filarial antigens [13]. Wedge resection of the nodule by itself is usually considered curative and medical treatment is not recommended [14]. There are suggestions indicating the use of ivermectin with or without Diethylcarbamazine (DEC) for treatment but are not widely accepted [15]. HPD has been misinterpreted as a lung cancer on chest imaging, thus accounting for unnecessary surgical interventions at times.