Sonographic images of hepato-pancreatico-biliary and intestinal ascariasis: A pictorial review.

Donboklang Lynser,Evarisalin Marbaniang,Chhunthang Daniala,Pranjal Phukan,Akash Handique

doi:10.1007/s13244-015-0428-7

Abstract

Despite advancement in the diagnosis and treatment of intestinal helminthiasis, ascariasis remains the most common cause of helminthic infections in the developing countries. Ultrasound offers a rapid, safe, and noninvasive approach to the diagnosis of intestinal ascariasis. Ultrasound is also the modality of choice for diagnosis of hepatobiliary ascariasis, which is relatively rare and is due to migration of intestinal worms through the papilla of Vater. We present an imaging spectrum of hepato-pancreatico-biliary and intestinal ascariasis.Main messages• Ascariasis refer to infestation by the round worm ascaris lumbricoides.• Ascaris eggs are excreted in faeces and are infective to humans.• Eggs hatch to larva, travel to the lungs and mature to adult worms.• Intestinal obstruction can be caused by multiple ascariasis forming bag of worms.

Highlights

Despite advancement in the diagnosis and treatment of intestinal helminthiasis, ascariasis remains the most common cause of helminthic infections in the developing countries
The adult worm is seen as a large, curved echogenic strip with an inner, anechoic, longitudinal canal [3]
We have found several linear calcified structures within the bile ducts that might be calcified dead worms, possibly representing remote hepatobiliary infestation

Summary

Spaghetti sign

Overlapping longitudinal interfaces in the main bile duct. 5. The worm in the CBD can be seen as single or multiple tubular, linear echogenic non-shadowing walls (strip sign) (Fig. 2). Too many worms inside the CBD can appear as multiple echogenic non-shadowing linear interfaces, giving a classical spaghetti sign (Fig. 3a ,b and c). Ascaris in the intrahepatic ducts are less common than the common bile duct They may be seen in either lobes of liver. The ascaris may be seen as a coil of worm in the gall bladder lumen (Fig. 7). Ascaris in the gallbladder is rare, constituting 2.1 % of hepatobiliary ascariasis [7]. Ascaris in the main pancreatic duct can present with pancreatitis. The main pancreatic duct may be dilated, with Btriple line sign^, Bstrip sign^ or an Binner tube sign^ and occasional pancreatic oedema (Fig. 9)

Discussion

Findings

Conclusion