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Parasitic Diseases of the Biliary Tract

Jae Hoon Lim1, So Yeon Kim2 and Cheol Min Park3

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-230, South Korea.
2 Department of Radiology, Asan Medical Center, Seoul, South Korea.
3 Department of Radiology, Guro Hospital, Korea University, Seoul, South Korea.


Figure 1
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  		Fig. 1 —Gross appearance of adult Clonorchis sinensis collected from feces. Flukes measure 8–15 mm long, 1.5–4.0 mm wide, and 1.0 mm thick (scale increment = 1 mm). (Reprinted with permission from Lim JH, Ko YT, Lee DH, Kim SY. Clonorchiasis: sonographic findings in 59 proved cases. AJR 1989; 152:761–764 [5])

 

Figure 2
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  		Fig. 2 —Photomicrograph of pathologic specimen shows adult fluke of Clonorchis sinensis in intrahepatic bile duct. Note adenomatous hyperplasia of mucosa and severe fibrous thickening of bile duct wall (arrows). (Masson's trichrome stain x40)

 

Figure 3
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  		Fig. 3 —45-year-old man with clonorchiasis. Endoscopic retrograde cholangiogram shows innumerable elongated or elliptic small filling defects, indicating adult Clonorchis sinensis (arrows) in peripheral small branches of bile ducts. Many peripheral bile ducts are occluded by flukes (arrowheads).

 

Figure 4
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  		Fig. 4 —65-year-old man with clonorchiasis. Sonogram of right hepatic lobe shows prominent and echogenic biliary radicles up to periphery, indicating severe thickening of peripheral bile ducts by chronic inflammatory change caused by Clonorchis sinensis infection.

 

Figure 5
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  		Fig. 5 —75-year-old man with severe clonorchiasis. Sonogram of gallbladder shows several small floating and elongated objects indicating adult Clonorchis sinensis. Sometimes these filling defects move spontaneously in bile.

 

Figure 6
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  		Fig. 6 —51-year-old man with mild infection of Clonorchis sinensis. CT image shows minimal dilatation of peripheral intrahepatic bile ducts (arrows).

 

Figure 7
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  		Fig. 7A —55-year-old man with moderate infection of Clonorchis sinensis. Contrast-enhanced portal venous CT images show profound dilatation of peripheral small bile ducts up to peripheral margin of liver. Central (large) intrahepatic ducts and extrahepatic ducts are not dilated (arrows, B and C).

 

Figure 8
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  		Fig. 7B —55-year-old man with moderate infection of Clonorchis sinensis. Contrast-enhanced portal venous CT images show profound dilatation of peripheral small bile ducts up to peripheral margin of liver. Central (large) intrahepatic ducts and extrahepatic ducts are not dilated (arrows, B and C).

 

Figure 9
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  		Fig. 7C —55-year-old man with moderate infection of Clonorchis sinensis. Contrast-enhanced portal venous CT images show profound dilatation of peripheral small bile ducts up to peripheral margin of liver. Central (large) intrahepatic ducts and extrahepatic ducts are not dilated (arrows, B and C).

 

Figure 10
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  		Fig. 7D —55-year-old man with moderate infection of Clonorchis sinensis. Endoscopic retrograde cholangiogram shows characteristic diffuse dilatation of intrahepatic bile ducts, especially peripheral small bile ducts. Right and left hepatic ducts and extrahepatic bile ducts are not dilated. There are several filling defects in gallbladder (arrows) indicating adult flukes.

 

Figure 11
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  		Fig. 8A —67-year-old man with severe infection of Clonorchis sinensis. Transverse MR cholangiogram shows diffuse dilatation of entire intrahepatic bile ducts. Note filling defects (arrows) within bile ducts due to adult flukes of C. sinensis.

 

Figure 12
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  		Fig. 8B —67-year-old man with severe infection of Clonorchis sinensis. Thick-slab coronal MR cholangiogram shows diffuse severe dilatation of peripheral intrahepatic ducts, moderate dilatation of lobar and segmental bile ducts, and minimal dilatation of extrahepatic ducts. Although there are many flukes in bile ducts, they are not visible because they are very flat. Small filling defects are aggregates of adult flukes (arrowheads). Note moderate dilatation of branch ducts of pancreas tail due to infection in most upstream ducts of pancreas (arrows).

 

Figure 13
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  		Fig. 9A —63-year-old man with hepatic fascioliasis. Contrast-enhanced transverse CT images at portal venous phase show clustered small low-attenuating lesions with peripheral enhancement at subcapsular area of right hepatic lobe. Note characteristic crooked tractlike lesion (burrow tract) (arrow, B).

 

Figure 14
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  		Fig. 9B —63-year-old man with hepatic fascioliasis. Contrast-enhanced transverse CT images at portal venous phase show clustered small low-attenuating lesions with peripheral enhancement at subcapsular area of right hepatic lobe. Note characteristic crooked tractlike lesion (burrow tract) (arrow, B).

 

Figure 15
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  		Fig. 9C —63-year-old man with hepatic fascioliasis. Photomicrograph of biopsy specimen shows eosinophilic granuloma (arrows) in liver. (H and E, x400)

 

Figure 16
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  		Fig. 10A —32-year-old woman with biliary fascioliasis. (Reprinted with permission from Ham SY, Park CM, Chung KB, et al. A case of fascioliasis in common bile duct. J Korean Radiol Soc 1989; 25:783–785 [13]) Endoscopic retrograde cholangiograms show several small elongated filling defects (arrows), which were movable on fluoroscopy.

 

Figure 17
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  		Fig. 10B —32-year-old woman with biliary fascioliasis. (Reprinted with permission from Ham SY, Park CM, Chung KB, et al. A case of fascioliasis in common bile duct. J Korean Radiol Soc 1989; 25:783–785 [13]) Endoscopic retrograde cholangiograms show several small elongated filling defects (arrows), which were movable on fluoroscopy.

 

Figure 18
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  		Fig. 10C —32-year-old woman with biliary fascioliasis. (Reprinted with permission from Ham SY, Park CM, Chung KB, et al. A case of fascioliasis in common bile duct. J Korean Radiol Soc 1989; 25:783–785 [13]) Adult Fasciola hepatica obtained from common bile duct at surgery. (scale increment = 1 mm)

 

Figure 19
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  		Fig. 11A —57-year-old woman with biliary ascariasis. Sonogram of extrahepatic duct shows two parallel lines indicating body surface of Ascaris lumbricoides.

 

Figure 20
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  		Fig. 11B —57-year-old woman with biliary ascariasis. Endoscopic retrograde cholangiogram shows convoluted long filling defect in extrahepatic duct indicating adult A. lumbricoides.

 

Figure 21
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  		Fig. 11C —57-year-old woman with biliary ascariasis. Endoscopic view during removal of adult A. lumbricoides from papillary orifice.

 

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