"serology: ELISA and other immunoassays are sensitive in early (pre-patent) infection 1,3,4"
"antiparasitics: triclabendazole is first-line and active against immature and adult flukes; WHO recommends 10 mg/kg once, and if treatment failure occurs, a second dose to a total of 20 mg/kg (often given as two doses 12–24 hours apart in clinical practice) 8,9"
"Fascioliasis is a zoonotic trematode infection caused by Fasciola hepatica and Fasciola gigantica, predominantly affecting the liver and biliary tree, and acquired by ingesting metacercariae on contaminated aquatic plants or water 1,2."
"Human infection by Fasciola species is termed fascioliasis (also “liver fluke disease”, historically “hepatic distomiasis”) 1."
"Fascioliasis has a global distribution, with hyperendemic foci where sheep/cattle husbandry, as well as freshwater snails (family Lymnaeidae), coexist. Risk increases with the consumption of raw aquatic plants (e.g. watercress) or untreated water. Travel-related and sporadic autochthonous cases occur in non-endemic countries 1,2."
"serology: ELISA and other immunoassays are sensitive in early (pre-patent) infection 1,3,4"
"ERCP"
"biliary complications: manage cholangitis/obstruction with antibiotics and endoscopic therapy (ERCP with extraction, dilation/stenting) as required 10"
"think fascioliasis when eosinophilia with RUQ pain and subcapsular serpiginous hepatic tracts (“tunnels and caves”) are present 4-7"
"on US/MRCP, mobile leaf-like intraductal defects are a strong clue in the biliary phase 4"
"acute phase: T2-hyperintense, T1-hypointense parenchymal tracts; restricted diffusion is variable; patchy periportal oedema; post-contrast faint peripheral or rim enhancement may be seen"
Expected headings
"ERCP"
"acute (hepatic/migratory) phase (weeks to months): fever, right upper quadrant pain, hepatomegaly, marked eosinophilia; variable LFT derangement"
"chronic (biliary) phase: biliary colic, cholestatic jaundice, cholangitis; intermittent symptoms from intraductal flukes and biliary sludge/strictures"
"Humans ingest metacercariae that excyst in the duodenum, penetrate the intestinal wall, migrate across the peritoneal cavity and Glisson’s capsule into hepatic parenchyma (acute phase), then enter and mature within intra/extrahepatic bile ducts (chronic phase). Tissue injury reflects necrotic/haemorrhagic tracks and eosinophil-rich inflammation in the liver; chronic disease shows ductal epithelial hyperplasia, periductal fibrosis and secondary bacterial infection 1,3."
"acute phase: multiple ill-defined hypoechoic tracks or clustered lesions, often subcapsular; capsular/perihepatic fluid may be present"
"chronic phase: mobile, leaf-shaped echogenic intraductal structures; bile duct wall thickening; variable ductal dilatation; sludge or small stones 3,4"
"chronic phase: mobile, leaf-shaped echogenic intraductal structures; bile duct wall thickening; variable ductal dilatation; sludge or small stones 3,4"
"chronic phase: mobile, leaf-shaped echogenic intraductal structures; bile duct wall thickening; variable ductal dilatation; sludge or small stones 3,4"
"lesions are poorly marginated, non-enhancing/low-enhancing; periportal oedema and perihepatic fluid can occur 4-7"
"chronic phase: mild to moderate bile duct dilatation, ductal wall thickening, periductal inflammatory change; linear/tubular intraluminal filling defects represent flukes or debris 4"
"acute phase: T2-hyperintense, T1-hypointense parenchymal tracts; restricted diffusion is variable; patchy periportal oedema; post-contrast faint peripheral or rim enhancement may be seen"
"acute phase: T2-hyperintense, T1-hypointense parenchymal tracts; restricted diffusion is variable; patchy periportal oedema; post-contrast faint peripheral or rim enhancement may be seen"
"acute phase: T2-hyperintense, T1-hypointense parenchymal tracts; restricted diffusion is variable; patchy periportal oedema; post-contrast faint peripheral or rim enhancement may be seen"
"chronic phase: ductal wall oedema/thickening on T2 and post-contrast; elongated intraductal filling defects on MRCP/3D T2 sequences; associated cholangitis or segmental atrophy in longstanding cases 3,4"
"chronic phase: ductal wall oedema/thickening on T2 and post-contrast; elongated intraductal filling defects on MRCP/3D T2 sequences; associated cholangitis or segmental atrophy in longstanding cases 3,4"
"linear/leaflike filling defects; mucous, sludge and strictures; flukes may be extracted endoscopically 10"
"linear/leaflike filling defects; mucous, sludge and strictures; flukes may be extracted endoscopically 10"
"antiparasitics: triclabendazole is first-line and active against immature and adult flukes; WHO recommends 10 mg/kg once, and if treatment failure occurs, a second dose to a total of 20 mg/kg (often given as two doses 12–24 hours apart in clinical practice) 8,9"
"prognosis: generally excellent with timely therapy; chronic disease may lead to recurrent cholangitis and strictures 3"
"pyogenic liver abscess: round lesions with thick enhancing walls, gas, marked restricted diffusion; lacks characteristic subcapsular tracts"
"amoebic abscess: solitary “anchovy paste” cavity, peripheral T2 hypointense rim, typical clinical setting; eosinophilia less prominent"
"toxocariasis/visceral larva migrans: eosinophilia with multiple small lesions, often wedge-shaped; exposure history differs 3,4"
"choledocholithiasis: discrete calcific stones; no mobile leaf-like defects; different epidemiology"
"choledocholithiasis: discrete calcific stones; no mobile leaf-like defects; different epidemiology"
"clonorchiasis/opisthorchiasis: diffuse peripheral ductal dilatation without marked common duct dilatation; different geography; praziquantel responsive"
"clonorchiasis/opisthorchiasis: diffuse peripheral ductal dilatation without marked common duct dilatation; different geography; praziquantel responsive"
"cholangiocarcinoma: irregular dominant stricture/mass, progressive enhancement, no eosinophilia; consider if focal masslike enhancement and no response to therapy"
"linear/leaflike filling defects; mucous, sludge and strictures; flukes may be extracted endoscopically 10"