J Korean Soc Radiol.  2015 Apr;72(4):291-294. 10.3348/jksr.2015.72.4.291.

Hepatobiliary Fascioliasis with Multiple Aneurysms and Active Bleeding: A Case Report

• Choi SY
• Kim JW
• Jang JC

• KMID: 1941761
• DOI: http://doi.org/10.3348/jksr.2015.72.4.291

Abstract

A 52-year-old woman visited our institution with upper abdominal pain which had lasted for the past two days. Laboratory tests revealed mild leukocytosis, decreased serum hemoglobin, and peripheral blood eosinophilia. CT scans showed multiple ill-defined, hypodense lesions in the peripheral areas of both hepatic lobes and active bleeding with a subcapsular hematoma in the right hepatic lobe. Angiography also showed active bleeding in the right hepatic lobe with multiple aneurysms, so a transarterial coil embolization was performed to stop the bleeding. The endoscopic retrograde cholangiopancreatography revealed several moving flat flukes in the common bile duct, which were pathologically confirmed as Fasciola hepatica.

MeSH Terms

Abdominal Pain
Aneurysm*
Aneurysm, Ruptured
Angiography
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct
Embolization, Therapeutic
Eosinophilia
Fasciola hepatica
Fascioliasis*
Female
Hematoma
Hemorrhage*
Humans
Leukocytosis
Middle Aged
Tomography, X-Ray Computed
Trematoda

Figure

• 

  Fig. 1 A 52-year-old woman with hepatobiliary fascioliasis. A, B. Contrast-enhanced four phase CT scans in arterial phase (A, B) show multiple ill-defined, hypodense lesions (black arrows) in the peripheral areas of both hepatic lobes. Some of the lesions are composed of hypoattenuating nodules and start at the peripheral area and point toward the central liver (black arrowheads). Active bleeding (white arrow) is seen in the right lobe of the liver with subcapsular hematoma. C, D. Celiac angiogram (C) shows multiple aneurysms at the peripheral tip of the intrahepatic arteries (black arrows). Hepatic angiogram (D) shows multiple aneurysms and active bleeding (white arrow) from one of aneurysms in the right hepatic lobe. E, F. Follow-up CT scans after a week. CT scans show cessation of the active bleeding (white arrow) but persistence of the subcapsular hematoma with no change. Most of the earlier-observed hypodense lesions are improved, but new lesions (black arrows) are seen at central area of liver. The migration of the hypodense lesions is verified. G. Endoscopic retrograde cholangiopancreatography shows 0.3 cm-sized moving flat flukes (white arrow). H. Flat flukes pathologically confirmed as Fasciola hepatica (H&E, × 100).

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