Cholangiocarcinoma in magnetic resonance cholangiopancreatography and fascioliasis in endoscopic ultrasonography

Abstract

Fascioliasis is a worldwide zoonotic infection with Fasciola hepatica and Fasciola gigantica. The zoonoses are particularly endemic in sheep-raising countries and are also endemic in Iran. Typical symptoms that may be associated with fascioliasis can be divided by phases of the disease, including the acute or liver phase, the chronic or biliary phase, and ectopic or pharyngeal fascioliasis. Cholestatic symptoms may be absent, and in some cases diagnosis and treatment may be preceded by a long period of abdominal pain, eosinophilia and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 4 years, with imaging suggesting cholangiocarcinoma. Considering a new concept of endoscopic ultrasonography, at last F. hepatica was extracted with endoscopic retrograde cholangiography.

Keywords: Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasonography; Fasciola hepatica; Magnetic resonance cholangiopancreatography.

Fig. 1

CT. The arrow points to the filling defects in the CBD.

Fig. 2

Magnetic resonance cholangiopancreatography shows one stricture in middle part of the CBD (circle).

Fig. 3

EUS view of the CBD. The arrows point to the mixed echoic circular mass lesion.

Fig. 4

Slight enlargement and filling defect on ERCP.

Fig. 5

F. hepatica in the duodenum. a The arrow points to the body of F. hepatica. b F. hepatica being removed through the papilla.

Fig. 6

The adult F. hepatica flukes measuring approximately 2.5-3 × 1-1.5 cm.