Hepatobiliary fascioliasis: imaging characteristics with a new finding.

PURPOSE The aim of this study was to present the imaging characteristics of patients with hepatobiliary fascioliasis and describe a new imaging finding. MATERIALS AND METHODS Imaging and clinical findings of five patients diagnosed with hepatobiliary fascioliasis were retrospectively evaluated. All patients were examined by abdominal ultrasonography (US) and computed tomography (CT); two were additionally evaluated by abdominal magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). Diagnosis was confirmed by serology and parasitology tests in all patients. RESULTS Presenting complaints were abdominal pain in four patients, with fever in one of the four. All patients also had eosinophilia and abnormal liver function tests. In all patients, US examinations showed multiple hypoechoic nodules or parenchyma heterogeneity. CT examinations showed linear or branching, and nodular hypodense lesions in the liver. As a new imaging finding, hyperdense materials were identified in the dilated bile duct in one patient. MRI showed T1 hypo and T2 hyperintense areas of liver parenchyma in two patients, with peripheral enhancement in one of them. Filling defects and dilation of the intra-extrahepatic bile ducts were identified by US and MRCP in two patients. In these two patients Fasciola flukes were removed by ERCP. Medical treatment (triclabendazole) was successful in all patients. CONCLUSION Hepatobiliary fascioliasis is a rare disease which may have typical imaging findings in the liver and bile ducts as seen in our patients. Imaging characteristics with clinical findings may have a diagnostic clue especially in endemic areas.