Case 377: Fascioliasis

Diagnostic Category:

Clinical Presentation:

52 year-old man from Switzerland with incidental finding in his liver on CT done for evaluation for deep vein thrombosis after presenting with pain and swelling of his right lower extremity. Patient enjoys walking in nature with his wife picking blueberries and rasberries, which he enjoys eating right away after washing them in nearby creeks. He also enjoys time with his grandchildren, playing and whistling through pipes, which he forms by rolling large grass leaves.

CT: Mimicking mass in the right lobe

Imaging Findings:

Four phase CT done after incidental finding on one-phase CT venogram for deep vein thrombosis (coronal image, arrow is pointing to thrombus in the right external iliac vein) shows mass-like hypovascular structure in segment 8 with irregular margins representing parenchymal necrosis and debris caused by the parasite fasciola hepatica.  Diagnosis was confirmed through biopsy, since cholangiocarcinoma was suspected on CT. Note there is a very subtle partially enhancing rim on arterial phase,  and no late enhancement.

Courtesy Dr. Gerd Stuckmann, Institute for Radiology and Nuclear Medicine, Kantonsspital Winterthur,  Switzerland.