[Infection with fasciola hepatica - a case series].
OBJECTIVE
Described are the clinical and, especially, the contrast-enhanced ultrasonographic presentation and recovery of four cases of fascioliasis occurring between December 2008 and February 2009.


METHODS
A detailed history, clinical examination and laboratory investigation were followed by contrast-enhanced ultrasonography of the liver and serological evidence for the presence of antibodies. A final contrast-enhanced ultrasound was performed 6 weeks after treatment with triclabendazole.


RESULTS
The patients displayed a variety of symptoms ranging from vasospastic myocardial infarction diagnosed via coronary angiography and a first-time occurrence of migraine as a result of hypereosinophilia to fever with weight loss and tumor-like liver lesions. The contrast-enhanced ultrasonographic hepatic changes in fascioliasis are characterized by segmental arterial hyperemia with emphasis on the liver periphery and subcapsular canalicular sparing corresponding to parenchymal necrosis and hemorrhage. In the later phases areas with inflammatory changes were unmasked due to phlebitis of the small portal vessels and granulomatous parenchymal changes. All four patients were successfully treated with triclabendazole without experiencing any serious side effects.


CONCLUSIONS
Contrast-enhanced ultrasonography is well suited for the diagnosis and monitoring of hepatic fascioliasis.
Weiss
D
D
Medizinische Klinik, Spital STSAG, Thun, Schweiz. daniel.weiss@spitalstsag.ch
Marti
G
G
Mouton
W
W
Wermke
W
W
Kummer
O
O
D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001706:Biopsy; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005211:Fascioliasis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed; D000077682:Triclabendazole; D014463:Ultrasonography
D000871:Anthelmintics; D001562:Benzimidazoles; D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D000077682:Triclabendazole; D013459:Sulfur Hexafluoride