Gallbladder Double-Diverticular: A Case Report المرارة مزدوجة التج: تقرير حالة
Ultrasound and Fascioliasis at MEDIC CENTER, Vietnam
1. PHAN THANH HAI-LE DINH VINH PHUC-NGUYEN THIEN HUNG-NGUYEN
THI THAO HIEN-PHAM THI THU THUY
MEDIC MEDICAL CENTER
ULTRASOUND and FASCIOLIASIS
@ MEDIC CENTER
2. 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.
3. Introduction
Fascioliasis 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
4. Introduction
A 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. 1995
2. Kabaalioglu A, Ceken K, Saba R, Artan R, Cevikol C,Yilmaz S. 2003
5. 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. 2003
4. Aubert A, Meduri B, Prat F. 2001
6. Patients and Methods
Cross-sectional study
Target 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.
9. 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
10. 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. 1984
7. Birjawi GA, Sharara AI, Al-Awar GN, et al. 2002
8. Van Beers B, Pringot J, Geubel A. 1990
11. 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.
