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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
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.
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
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
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
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.
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
TABLE : INTRAHEPATIC and EXTRAHEPATIC LESIONS due to Fasciola sp
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
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. 1984
7. Birjawi GA, Sharara AI, Al-Awar GN, et al. 2002
8. 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
Conclusion
Ultrasound is useful to find not only the
images of liver damage but also the
extrahepatic lesions in our cases in
fascioliasis.

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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.
  • 7. 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
  • 8. TABLE : INTRAHEPATIC and EXTRAHEPATIC LESIONS due to Fasciola sp 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
  • 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.
  • 13. THORACIC WALL ABSCESS and PLEURAL EFFUSION
  • 15. FASCIOLA sp in GALLBLADDER
  • 16. INTRAABDOMINAL and BOWEL WALL THICKENING
  • 19. Conclusion Ultrasound is useful to find not only the images of liver damage but also the extrahepatic lesions in our cases in fascioliasis.