Fasciola hepatica infection

Bệnh nhân nữ 46 tuổi, tiền sử khỏe mạnh vào viện : - đau tức ẩm ỉ vùng hạ sườn phải - mệt mỏi, có sốt - không nôn, không tiêu chảy - không vàng da Bệnh diễn tuần Ultrasould Khối giảm âm Dịch CT CT tiêm thuốc : - Khối giảm tỷ trọng khơng đồng nhất, ngấm thuốc kém, có viền ngấm thuốc ngoại vi - Không đè đẩy/ xâm lấn mạch máu - Ngấm thuốc khơng tiến triển TM Vùng nhu mô gan rối loạn tưới máu lân cận Blood test, imaging techniques, indirect immunological tests are presently used for diagnosis - Blood test : Eosinophilia increase - AST, ALT significantly increase weeks post infection - GGT activity increases weeks post infection -  Plasma levels of IgG directed against F hepatica increase in weeks afer infection Radiological Imaging Features - US - CT - MRI Parenchymal phase Ductal phase 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  Ductal phase Parenchymal lesions regress Ductal dilatation Sometimes US can demonstrate mobile fluke 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 DIAGNOSIS Amoebic liver abscess Conclusion 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 ... 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... significantly increase weeks post infection - GGT activity increases weeks post infection -  Plasma levels of IgG directed against F hepatica? ?increase in weeks afer infection Radiological Imaging... 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