Radiological Imaging Features of Fasciola hepatica Infection – A Pictorial Review

Department of Radiology, University of Rochester Medical Center, Rochester, NY, US.
Journal of Clinical Imaging Science 01/2012; 2(1):2. DOI: 10.4103/2156-7514.92372
Source: PubMed


Fascioliasis refers to a zoonosis caused by Fasciola hepatica, a trematode infecting herbivores, but also occurs in humans who ingest the metacercaria found in fresh water plants. Infection in humans is common in developing countries and is also not uncommon in Europe. Diagnosis of this infection is difficult, as the history and symptoms are nonspecific and stool analysis for eggs is negative until the disease is in an advanced state by when the parasite has reached the biliary system. The clinical course consists of two phases; first a hepatic parenchymal phase in which immature larvae invade the liver parenchyma, followed by a ductal phase characterized by the excretion of larvae into the bile ducts. Parenchymal Phase: Ultrasonography (US) findings are nonspecific in this early phase. Computerized tomography (CT) may demonstrate subcapsular low attenuation regions in the liver. Magnetic Resonance imaging (MRI) can also be utilized to establish liver parenchymal involvement, and is better than CT in characterizing hemorrhagic lesions, as well as identifying more lesions relative to CT. Ductal Phase: US examination is most useful at this stage, with its ability to demonstrate the live movement of the worms within the dilated ducts. A CT demonstrates dilated central biliary ducts with periportal tracking, whereas, mild ductal dilatation is poorly appreciated under MRI. Therefore, familiarity with the multimodality imaging features of fascioliasis, in combination with an available confirmatory enzyme-linked immunoassay, would be most helpful for early diagnosis.

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Available from: Abdurrahim Dusak,
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    • "Parenchymal lesions regress with the beginning of the ductal phase. Sometimes US can demonstrate mobile flukes in the dilated bile ducts and gallbladder.18 F. hepatica infection should be considered if CT reveals hypodense nodules without enhancement and tunnel-like linear hypodense lesions in liver.19 "
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    ABSTRACT: Fascioliasis is a worlwide parasitic zoonosis, endemic in south-east mediterranean area, but uncommon in other areas. Clinical signs are usually non-specific. A 32 year old male patient was admitted to our hospital with complaints of abdominal pain, diarrhea, fatigue, nausea, lost of appetite, itching, cough, night sweats and weight loss. Complete blood count revealed hypereosinophilia. The abdominal ultrasound scan was normal. But computed tomography scan revealed irregular nodular lesions in periportal area of the liver. Based on these clinical and radiological signs and continuous hypereosinophilia, the patient was serologically investigated for Fasciola hepatica infection. F. hepatica indirect hemagglutination test in serum was positive at a titer of 1/1280. Single dose Triclabendasole 10mg/kg was administered and repeated two weeks later. Clinical and laboratory signs were completely resolved after treatment. Serological tests for fascioliasis should be included in all patients with hypereosinophilia and abnormal liver CT.
    Mediterranean Journal of Hematology and Infectious Diseases 01/2012; 4(1):e2012029. DOI:10.4084/MJHID.2012.029
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    ABSTRACT: Fascioliasis is primarily an infection of livestock such as cattle and sheep, caused by the flat, brown liver fluke Fasciola hepatica. Humans are accidental hosts. The diagnosis of infection depends on suspicion. Radiologic findings are specific. Usually, Computed Tomography (CT) and other imaging studies show hypodense migratory lesions of the liver. The development of a chronic liver abscess appears to be extremely rare. Here we present our case with hepatic abscess due to F. hepatica, which is a rare clinical presentation.
    Turkiye parazitolojii dergisi / Turkiye Parazitoloji Dernegi = Acta parasitologica Turcica / Turkish Society for Parasitology 01/2013; 37(4):305-6. DOI:10.5152/tpd.2013.2998
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    ABSTRACT: ABSTRACT Objective: Fasciola hepatica is a parasite that affects ruminant animals and is rarely seen in humans. The agent may cause significant health problems and economic loss as a zoonotic disease. Freshwater plants play an important role for infecting humans with this parasite. Eating watercress, drinking water that contains metacercaria, using contaminated kitchen tools, or consuming green vegetables may cause infestation. Green vegetables and fruits, especially watercress, are grown specifically in the Cukurova region and this puts the population living in this region at risk of developing fasciolosis. For the reason of absence of the seroprevalence studies in autopsies and to determine the prevalence of this region, the aim of this study, is to investigate F. hepatica antibody by the method of IHA blood samples which were taken from autopsy cases in the Çukurova Region. Material and Methods: This study was conducted in Adana Forensic Medicine Department, a center where all forensic autopsies from the cities of Adana, Mersin, Kahramanmaras, Hatay and Osmaniye were performed. There were 94 subjects between the ages of 2-87 years (mean:42.55±SD22.09) and their serum samples were collected for assessment of F. hepatica antibodies via the IHA method. Moreover, we examined the hepatobiliary system for adult parasites. Results: IHA results demonstrated that 13 (13.8%) of the subjects were seropositivite for F. hepatica. During the autopsy, however, mature F. hepatica was not observed in hepatobiliary systems of the subjects. Seropositivity rates in Adana, Mersin, Hatay and Osmaniye were 19.4%, 7.1%, 12.5% and 22.2%, respectively. Conclusion: To our knowledge, this is the first study evaluating F. hepatica seropositivity in forensic autopsies. Seeing the results, we suggest that more comprehensive epidemiologic research is needed to study this infestation, especially in endemic areas.
    Turkiye Klinikleri Journal of Medical Sciences 06/2013; 33(2):501-504. DOI:10.5336/medsci.2012-30826 · 0.10 Impact Factor
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