ULTRASOUND and FASCIOLIASIS @ MEDIC CENTER

PHAN THANH HAI-LE DINH VINH PHUC-NGUYEN THIEN HUNG-NGUYEN THI THAO HIEN-PHAM THI THU THUYMEDIC MEDICAL CENTER

SUMMARY We presented 126 cases of liver focal

infiltrating scanning by ultrasound with positive serodiagnostics of Fasciola and high elevated rate of eosinophil white blood cells in a population in central Vietnam. Beside intrahepatic cases we have 02 cases of intraabdominal lesion, 06 cases in biliary tract, 01 case in gallbladder, 01 case of subcutaneous abscess and 01 case of cutaneous lesion of fascioliasis.

IntroductionFascioliasis is caused by the liver flukes,

Fasciola hepatica or Fasciola gigantica.Patients are classified according to the

duration of their symptoms and the ultrasonographic findings1.

An acute stage (≤4 months) is characterized by fever, eosinophilia, and hepatosplenomegaly which coincides with the invasion of the liver by the larvae1;

1. Arjona R, Riancho JA, Aguado JM. 1995

IntroductionA chronic stage (>4 months) in which

symptoms are induced by the presence of the adult flukes in the biliary system within 2-3 months1.

Serology is highly sensitive and specific both in the acute and chronic phases.

Sometimes, moving parasite within the gallbladder or biliary ducts may be observed by ultrasound.

Sonography is more sensitive than compute tomography in the biliary phase2.

1. Arjona R, Riancho JA, Aguado JM. 19952. Kabaalioglu A, Ceken K, Saba R, Artan R, Cevikol C,Yilmaz S. 2003

Introduction

Ultrasonography is an imaging modality, which is becoming more widely available in regions of the world where Fasciola sp infestation is prevalent3,4.

In this report, we described the sonographic findings of hepatic and extrahepatic lesions in 126 cases with fascioliasis.

3. Sotoodehmanesh R, Yoonessi A. 20034. Aubert A, Meduri B, Prat F. 2001

Patients and MethodsCross-sectional studyTarget population was some conscious

patients with suspicious diagnosis of hepatic fascioliasis residing in Vietnam. They were included, if they had a positive anti-fasciola antibody.

Abdominal sonography was performed using a 3.5 MHz transducer.

RESULTS• INTRAHEPATIC= 126

INTRAPARENCHYMEAL= 126 / 100% IN BILIARY TRACT= 06/ 4.7% IN GALLBLADDER= 01/ 7.9 %X10-3

• INTRAABDOMINAL= 02/1.58%X10-3

• SUBCUTANEOUS= 01 ABSCESS / 7.9 %X10-3

• CUTANEOUS= 01/ 7.9 %X10-3

ULTRASOUND FINDINGS Number Proportion %n = 126

INHOMOGENEOUS PARENCHYMA 126 100.0

SUBCAPSULAR 21 16.67

5-6 SUBSEGMENT 45 35.71

MICROABSCESS 63 50.00

HYPOECHOIC LESION 21 16.67

HYPERECHOIC LESION 31 24.60

MICROCALCIFICATION 0

HILAR NODE 03 02.3

LESION LIKE HEMANGIOMA 01 7.9X10-3

BILIARY THICKENING 39 30.95

GALLBLADDER WALL EDEMA 05 3.96

OLYMPIC RING SIGN 4 3.17

EXTRAHEPATIC FLUID COLLECTION 02 1.58

BILIARY FOREIGN BODIES 6 4.76

TABLE : INTRAHEPATIC and EXTRAHEPATIC LESIONS due to Fasciola sp

Discussion

Sonography can show two types of lesions in the acute phase of fascioliasis. One type usually consists of multiple non-specific round lesions of variable echogenicity. The second type of lesion is composed of tunnel-like branching spaces that are better defined after injection of contrast medium in CT. These peripherally-located tortuous lesions are caused by migration of parasites through the liver5.5. Cosme A, Ojeda E, Poch M. 2003

Discussion

In the chronic phase of fascioliasis, typical sonographic findings are multiple sites of floating or mobile echogenic material in the gallbladder or biliary tree with no acoustic shadowing6,7.

Other non-specific findings are dilatation and irregular wall thickening of the bile ducts8.

6. Bonniaud P, Barthelemy C, Veyret C. 19847. Birjawi GA, Sharara AI, Al-Awar GN, et al. 20028. Van Beers B, Pringot J, Geubel A. 1990

Discussion

We found echogenous foci without posterior shadow. It can be differentiated from stone by the lack of posterior shadow.

Some sonographic findings, like mobile echogenous foci without posterior shadow in the gallbladder and biliary tracts, considering the characteristic leaf-shape appearance, are very helpful.

OLYMPIC RINGS

THORACIC WALL ABSCESS and PLEURAL EFFUSION

INTRABILIARY and GALLBLADDER

FASCIOLA sp in GALLBLADDER

INTRAABDOMINAL and BOWEL WALL THICKENING

INTRAABDOMINAL and MESENTERIC EDEMA

CUTANEOUS FASCIOLIASIS

Before treatment

Post treatment

ConclusionUltrasound is useful to find not only the images of liver damage but also the extrahepatic lesions in our cases in fascioliasis.