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PICTORIAL EDUCATION Table of Contents   
Year : 2009  |  Volume : 1  |  Issue : 2  |  Page : 144-145
Biliary ascariasis on magnetic resonance cholangiopancreatography


1 EKO CT and MRI Scan Centre, At Medical College and Hospitals Campus, 88-College Street, Kolkata-700 073, India
2 Medical College and Hospitals, Kolkata, India

Click here for correspondence address and email

Date of Web Publication3-Oct-2009
 

   Abstract 

A 17-year-old girl presented with features of biliary obstruction. Magnetic resonance cholangi-pancreatography revealed typical linear signals in common bile duct, which appears like Ascaris lumbricoides. The diagnosis was confirmed by endoscopic removal of the worm.

Keywords: Ascaris lumbricoides, Common bile duct, Magnetic resonance cholangi-pancreatography

How to cite this article:
Hashmi MA, De JK. Biliary ascariasis on magnetic resonance cholangiopancreatography. J Global Infect Dis 2009;1:144-5

How to cite this URL:
Hashmi MA, De JK. Biliary ascariasis on magnetic resonance cholangiopancreatography. J Global Infect Dis [serial online] 2009 [cited 2019 Oct 20];1:144-5. Available from: http://www.jgid.org/text.asp?2009/1/2/144/56248



   Introduction Top


Parasite infecion of the biliary tract is a common complication. Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, and Dicrocoelium dendriticum are closely related to C. sinensis and can also cause serious biliary complications. Fascioliasis, caused by Fasciola hepatica and F. gigantica, is a zoonotic helminthiasis that can present as acute hepatic or chronic biliary tract infection. [1] Ascaris lumbricoides is the most common cause of parasitic infection of bile duct. [2],[3],[4] Occasionally, the adult Ascaris worm may cross into vater's ampulla and enter the bile duct, gall bladder or pancreatic duct, leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis. Computed tomography (CT), Magnetic resonance imaging (MRI), and ultrasound are useful imaging tools to identify these parasites and their complications. Recently, MRCP has been playing a significant role in diagnosing biliary infection by Ascaris.


   Case Report Top


A 17-year-old female presented to us with pain abdomen. Patient liver function test showed mild changes. Ultrasound had shown few linear echogenicites in common bile duct (CBD). MRI revealed hypointense dot type signal in center of CBD in axial imaging [Figure 1]. Single shot MRCP showed linear hypointense signal in CBD [Figure 2] and [Figure 3]. The worm was removed endoscopically and the patient improved gradually.


   Discussion Top


Ascaris lumbricoides is one of the most common parasitic infections worldwide. An adult worm is typically 15-50 cm long and 3-6 mm thick. During the intestinal phase the worms may be silent or cause abdominal pain, vomiting or bowel obstruction. Migration of a worm through the papilla of vater into the biliary tree is an uncommon complication and leads to biliary colic, recurrent pyogenic cholangitis, pancreatitis, hepatic abscesses and septicemia. [4],[5],[7] These irritating factors can even lead to cholangiocarcinoma. [1]

Ulttrasound (US) is the imaging modality of choice for biliary problems. US findings of biliary ascariasis have been described as tubular, echogenic, non-shadowing structures, sometimes with a thin, longitudinal, central sonolucent line. Movement of worms can also be seen. [2],[7]

MRI and MRCP are good imaging modalities to detect the above condition. Axial images in T2 weighted sequence shows a dot hypointense signal in CBD around which the bile signals are hyperintense. MR cholangiography shows intraductal worms as linear hypointense filling defects.


   Conclusion Top


US , CT and other modalities can detect biliary Ascariasis while MRI with MRCP is very effective in detecting intraductal Ascariasis. They can be seen as linear hypointensities intraluminally along the course of CBD.

 
   References Top

1.Rana SS, Bhasin DK, Nanda M, Singh K. Parasitic infestations of the biliary tract. Curr Gastroenterol Rep 2007;9: 156-64.  Back to cited text no. 1  [PUBMED]    
2.Hwang CM, Kim TK, Ha HK, Kim PN. Biliary ascariasis: MR cholangiography findings in two cases. Korean J Radiol 2001;2:175-8.  Back to cited text no. 2      
3.Fitoz S, Atasoy C. MR cholangiography in massive hepatobiliary ascariasis. Acta Radiol 2000;41:273-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Danaci M, Belet U. MR imaging features of biliary ascariasis. AJR Am J Roentgenol 1999;173:503.  Back to cited text no. 4      
5.Lim JH, Kim SY, Mi C. Parasitic diseases of the biliary tract. AJR Am J Roentgenol 2007;188:1596-603.  Back to cited text no. 5      
6.Uysal G, Sebalaban KA, Gaven A. Biliary ascariasis. Indian J Pediatric 2001;68.  Back to cited text no. 6      
7.Das CJ, Kumar J, Debnath J, Chaudhry A. Imaging of ascariasis. Australas Radiol 2007;51:500-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Mohammad A Hashmi
EKO CT and MRI Scan Centre, At Medical College and Hospitals Campus, 88-College Street, Kolkata-700 073
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.56248

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 3 T MR cholangiopancreatography appearances of biliary ascariasis
Z.X. Ding, J.H. Yuan, V. Chong, D.J. Zhao, F.H. Chen, Y.M. Li
Clinical Radiology. 2011; 66(3): 275
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    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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