Imaging findings of human hepatic fascioliasis: a case report and review of the literature

Abstract

Background Fascioliasis is a food-borne hepatobiliary zoonosis caused by Fasciola hepatica and Fasciola gigantica. Human infestations are predominantly seen in developing countries where the disease is endemic, but, due to the increase in international travel rates, hepatic fascioliasis is also appearing in nonendemic areas including Europe and the USA. The clinical and laboratory findings are usually nonspecific. Cross-sectional imaging can be very helpful in the diagnosis of fascioliasis as well as to differentiate it from other liver diseases with a very similar clinical picture. The objectives of this case report are to discuss imaging findings of hepatic fascioliasis and to review the literature. Case presentation We report the case of a 35-year-old Iranian patient who presented with right upper quadrant pain, low-grade fever, fatigue, and anorexia. The patient had a history of recent travel to the Gilan Province of Iran, almost a month before the onset of symptoms, which is an endemic area of fascioliasis in the country. Laboratory examinations revealed eosinophilia, elevated hepatic enzymes, and slightly raised C-reactive protein. Contrast-enhanced computed tomography of the patient shows clusters of focal ill-defined hypodense lesions with mild peripheral enhancement in the right liver lobe and subcapsular regions. Magnetic resonance imaging of the liver revealed multiple ill-defined lesions of low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, extending from the liver capsule into deeper parenchyma toward periportal regions, which shows mild peripheral enhancement on post-contrast images. Imaging-based diagnosis of fascioliasis was made depending on the characteristic distribution of subcapsular tracts/lesions on the above-mentioned imaging, which was then confirmed by serologic tests using enzyme-linked immunosorbent assay. The patient was treated with triclabendazole, showing great clinical improvement, and was eventually discharged in good health condition. Conclusion The imaging findings in this case report highlight the importance of cross-sectional imaging for further evaluation of suspected cases of fluke-induced liver disease. The hypothesis of hepatic fascioliasis should be always considered when consistent radiological findings are observed. Clusters of tortuous subcapsular lesions with peripheral contrast enhancement extending into deeper liver parenchyma are characteristic imaging findings that strongly suggest hepatic fascioliasis.

Liver fluke in a young Nepalese girl: A rare diagnostic puzzle

“…Endoscopic retrograde cholangiopancreatography (ERCP) appears to have a dual role in the diagnosis and treatment of fascioliasis, as it allows the detection and extraction of motile parasite(s). Common findings are linear, elliptical, or rounded filling defects inside a dilated biliary or pancreatic duct 10 …”

“…9 Hepatic parenchymal lesions are best diagnosed on CT, as it can appropriately identify the classical "tunnel and caves sign" corresponding to the path of migration of F. hepatica through the liver parenchyma. 10 An MRI, on the other hand, demonstrates the characteristic evolutionary pattern of fascioliasis, reflecting the life cycle of the parasite in the early parenchymal phase even without contrast as capsular hyperintensity on T2weighted images. It may also provide additional details about complications such as hemorrhagic lesions and abscess formation.…”

Hepatic and Extrahepatic Fascioliasis Mimicking Colon Cancer with Hepatic Metastasis

“…Freshwater snails are intermediate hosts, and mammals, including humans, are definitive hosts (1). When encysted larvae from contaminated water are ingested by humans, the larvae penetrate the duodenal wall, enter the liver through the peritoneum and Glisson's capsule, and settle in the bile duct or gallbladder (1,10).…”

“…The two stages in which the larvae infect the liver and cause symptoms are broadly divided into hepatic (acute) and biliary (chronic) (8,9). In the hepatic stage, the main symptoms are urticaria, abdominal pain, and fever, and in the biliary stage, intermittent abdominal pain and cholangitis or cholestasis are accompanied (9,10). Similarly, it is divided into the parenchymal and ductal phases in radiology (1).…”

“…Similarly, it is divided into the parenchymal and ductal phases in radiology (1). In the parenchymal phase, multiple microabscesses are seen at the migration site of the larva, and a tunnel-like tract is seen at the entry site of Glisson's capsule (8,10). Upon penetration of the parenchyma, clustered abscesses appear as caves with a serpentine pattern.…”