title: Hepatic visceral larva migrans, a resilient entity on imaging: Experience from a tertiary liver center.
abstract: BACKGROUND
  Hepatic visceral larva migrans (VLM) is an uncommon parasitic manifestation seen in the liver. It presents as coalescing, conglomerated, or solitary abscess cavities in the liver on imaging. We conducted a retrospective clinico-radiological analysis of 24 patients with biopsy proven VLM who were reviewed and followed up at our tertiary liver institute over a period of 4 years.
  
  
  METHODS
  The study was performed to correlate the radiological features and imaging response to therapy for hepatic VLM. The disease course, imaging findings, progressive, absolute eosinophil counts (AEC), hydatid serology, and the extent of radiological regression of the liver lesions, on follow-up were analyzed.
  
  
  RESULTS
  Imaging showed a diagnostic accuracy of 42%. Hydatid serology was positive in 46% patients before starting treatment. The median pretreatment AEC of 507 showed a significant posttreatment AEC decline to median value of 117. The Wilcoxon signed ranks test showed significant decline in the AEC (P < 0.001). Radiological regression was present in all lesions. However, patients showed residual abscesses on imaging, up to 2 years on follow-up.
  
  
  CONCLUSIONS
  This study reveals that AEC has a significant predictive value in diagnosis and as a marker for disease regression. Complete radiological resolution of hepatic lesions does not correlate with total clinical remission. This finding warrants the need for further studies to look into the role of prolonged medical therapy or surgery as an alternate to current therapy module in cases of hepatic visceral larva abscesses.
authors.affiliation: Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shalini Thapar
authors.initials: ST
authors.lastname: Laroia
authors.affiliation: Department of Hepato Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Hepato Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Chhagan
authors.initials: C
authors.lastname: Bihari
authors.affiliation: Department of Community Medicine and Public Health, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Ajeet Singh
authors.initials: AS
authors.lastname: Bhadoria
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
keywords: Absolute eosinophil count; antihelminthic therapy; hepatic; imaging; visceral larva migrans