Korean J Radiol.  2010 Aug;11(4):480-484. 10.3348/kjr.2010.11.4.480.

Imaging Features of Pediatric Pentastomiasis Infection: a Case Report

• Lai C
• Wang XQ
• Lin L
• Gao DC
• Zhang HX
• Zhang YY
• Zhou YB

• KMID: 984904
• DOI: http://doi.org/10.3348/kjr.2010.11.4.480

Abstract

We report here a case of pentastomiasis infection in a 3-year-old girl who had high fever, abdominal pain, abdominal tension and anemia. Ultrasound scanning of the abdomen revealed disseminated hyperechoic nodules in the liver and a small amount of ascites. Abdominal MRI showed marked hepatomegaly with disseminated miliary nodules of high signal intensity throughout the hepatic parenchyma on T2-weighted images; retroperitoneal lymphadenopathy and disseminated miliary nodules on the peritoneum were also noted. Chest CT showed scattered small hyperdense nodules on both sides of the lungs. The laparoscopy demonstrated diffuse white nodules on the liver surface and the peritoneum. After the small intestinal wall and peritoneal biopsy, histological examination revealed parenchymal tubercles containing several larvae of pentastomids and a large amount of inflammatory cell infiltration around them. The pathological diagnosis was parasitic granuloma from pentastomiasis infection.

Keyword

Pentastomiasis; Magnetic resonance (MR); Parasitic disease, abdomen; Ultrasonography

MeSH Terms

Abdomen, Acute/*parasitology
Animals
Biopsy
Child, Preschool
Diagnosis, Differential
Female
Humans
Magnetic Resonance Imaging/methods
Parasitic Diseases/*diagnosis
*Pentastomida
Tomography, X-Ray Computed/methods

Figure

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  Fig. 1 3-year-old girl with pentastomiasis infection, and she had high fever, abdominal pain, abdominal tension and anemia. A. Abdominal ultrasonography reveals disseminated miliary hyperechoic nodules in liver (arrow). B. T1-weighted transverse MRI (TR, 1,540 ms; TE, 2.3 ms) reveals marked hepatomegaly with miliary nodular lesions (2-4 mm diameter) of low signal intensity throughout hepatic parenchyma (arrow). C. T2-weighted transverse MRI (TR, 4,577 ms; TE, 101 ms) reveals marked hepatomegaly with disseminated nodular lesions of high signal intensity throughout hepatic parenchyma (arrow). D, E. T2-weighted coronal MRI (TR, 3.7 ms; TE, 1.9 ms) shows disseminated miliary mesenteric lymph nodes (short arrows, D), peritoneal nodules (long arrow, D) and diffuse retroperitoneal lymphadenopathy of high signal intensity (arrow, E). F. Chest CT shows multiple small hyperdense nodules in both lungs on lung window (arrow). G. Cross section of pentastomid worm in peritoneum shows primordial genital tract (GT), red acidophilic gland (AG), intestine (IN) and worm wall (black arrow), which are surrounded by group of macrophages and inflammatory cells and fibrosis (white arrow) (Hematoxylin & Eosin stain, × 40). H. Vital well-preserved pentastomid worm from patient feces. Worm is cylindrical, translucent and has prominent spiral rings (arrow). We can see its chest, abdomen and blunt round tail, which is gradually shrinking.

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