Fasciola hepatica infection

CT tiêm thuốc :- Khối giảm tỷ trọng không đồng nhất, ngấm thuốc kém, có viền ngấm thuốc ngoại vi - Không đè đẩy/ xâm lấn mạch máu - Ngấm thuốc không tiến triển thì TM... Tóm tắtBệnh nhân

Bệnh nhân nữ 46 tuổi, tiền sử khỏe mạnh vào viện vì :

- đau tức ẩm ỉ vùng hạ sườn phải

Khối giảm âm

Dịch

CT

CT tiêm thuốc :

- Khối giảm tỷ trọng không đồng nhất, ngấm thuốc kém, có viền ngấm thuốc ngoại vi

- Không đè đẩy/ xâm lấn mạch máu

- Ngấm thuốc không tiến triển thì TM

Vùng nhu mô gan rối loạn tưới máu lân cận

Tóm tắt

Bệnh nhân nữ 46 tuổi, tiền sử khỏe mạnh:

- đau tức ẩm ỉ vùng hạ sườn phải 2 tuần

- mệt mỏi, thỉnh thoảng có sốt

- tổn thương trên nền gan không xơ, HBV (-)

- tổn thương ranh giới không rõ, không đè đẩy/ xâm lấn đường đi của mạch máu, tính chất ngấm thuốc không điển hình với các loại u gan

- xét nghiệm tăng bạch cầu ưa acid

=> Nghĩ nhiều đến tổn thương viêm do ký sinh trùng

2 common lesions liver caused by parasite

- Amip absces

- Fasciola hepatica

Amip abscess liver

The lesion is typically oval or round and located in right liver and near the liver dome

A contrast-enhanced CT demonstrates well-defined round lesions, with

complex fluid attenuation values A thick enhancing wall with peripheral edema

Fasciola hepatica Infection  

CT findings in the parenchymal phase include multiple, small, round, or oval clustered hypodense lesions, with peripheral contrast enhancement 

In addition the CT may demonstrate subcapsular, low-attenuation regions in the liver, secondary to penetration of the parasites into the Glisson capsule

Fasciola hepatica Infection  

The parasitic infection in humans begins when water plants, containing larva

The larva excyst in the stomach and penetrate the duodenal wall, escape into the peritoneal cavity, and then penetrate the Glissons capsule, entering the liver parenchyma

In the liver:

- the flukes slowly migrate randomly through

the hepatic parenchyma making multiple small holes and cavities, causing inflammation,

abscess formations, hemorrhage, necrosis,

granulation, and fibrosis

- they reach the larger bile duct and penetrate into the lumen, which is their permanent

residence

Blood test, imaging techniques, indirect

immunological tests are presently used for

diagnosis

- Blood test : Eosinophilia increase

- AST, ALT significantly increase 4 weeks post infection

- GGT activity increases 9 weeks post infection

-  Plasma levels of IgG directed against F  

hepatica increase in 2 weeks afer infection 

Radiological Imaging Features

Parenchymal phase

- US findings are nonspecific in this early phase

- Until eight weeks post infection

- US findings include focal hypoechoic or hyperechoic lesions or diffuse involvement of the liver

CT findings in the parenchymal phase of hepatic fascioliasis include multiple, small, round, or oval clustered hypodense lesions, with peripheral contrast enhancement 

In addition the CT may demonstrate subcapsular, low-attenuation regions in the liver Focal liver capsule thickening and enhancement can be

demonstrated on CT, secondary to penetration of the parasites into the

Glisson capsule

Parenchymal clustered lesions show hyperintensity on T2W and hypointensity on T1W images, with peripheral enhancement afer contrast administration 

A contrast-enhanced CT scan shows low attenuation tracks along the portal triads

Residual parenchymal liver calcification may rarely be seen in the chronic phase

Mild dilated bile ducts appear on T2W images

Intermediate signal-filling defects representing worms can be seen in the dilated ducts

Complications

- unilocular or multifocal abscess possibly due to pus

or hemorrhage

- acute cholangitis and cholecystitis

- the chronic stage of fascioliasis is characterized by recurrent episodes of biliary colic, cholecystitis

DIFFERENTIAL DIAGNOSISAmoebic liver abscess

Imaging findings may help in a better

understanding of the life cycle characteristics of the disease and describe the findings in which fascioliasis should be suspected

Early diagnosis, with demonstration of the exact phase of the disease would be helpful for

appropriate treatment