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Ultrasound
Diagnosis
Liver
Cyst and Cyst-Like Lesions
CEUS Liver: Parasitic Disease and Tuberculosis
CEUS Liver: Parasitic Disease and Tuberculosis
Jinrui Wang, MD; Qiang Lu, MD; Ji-Bin Liu, MD
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KEY FACTS

  • Terminology

    • IMAGING

      TERMINOLOGY

      • Parasitic Disease

        • Echinococcosis: Parasitic disease of tapeworms of Echinococcus genus
          • 2 main types
            • Cystic echinococcosis, a.k.a. hydatid disease, is caused by infection with larval stage of Echinococcus granulosus
            • Alveolar echinococcosis is disease caused by infection with larval stage of Echinococcus multilocularis
        • Clonorchiasis and opisthorchiasis: Helminthic diseases caused by liver flukes Clonorchis sinensis, Opisthorchis felineus, and Opisthorchis viverrini, respectively, spreading thorough raw or undercooked fish, crabs, or crayfish
          • Liver flukes infect liver, gallbladder, and bile duct in humans
        • Fascioliasis: Parasitic infection typically caused by flukes Fasciola hepatica and Fasciola gigantica, spreading through raw watercress or other water plants contaminated with immature parasite larvae
          • Immature larval flukes migrate through intestinal wall, abdominal cavity, and liver tissue, into bile ducts
        • Paragonimiasis: Food-borne parasitic infection spreading through raw or undercooked freshwater crabs or crayfish infected with Paragonimus metacercariae
        • Ascariasis: Caused by infection with Ascaris lumbricoides adult worm, which might migrate from small bowel into bile duct, gallbladder, &/or liver parenchyma

      • Hepatic Tuberculosis

        • Hepatic tuberculosis (TB) is always associated with systematic dissemination of TB infection
        • Often unrecognized and missed because of its relatively nonspecific clinical presentations

      IMAGING

      • US Findings

        • CEUS Findings

          • Differential Diagnosis

            Selected References

            1. Dietrich CF et al: Never seen before? Opisthorchiasis and clonorchiasis. Z Gastroenterol. 56(12):1513-1520, 2018
            2. Dietrich CF et al: Ascariasis imaging: pictorial essay. Z Gastroenterol. 55(5):479-489, 2017
            3. Dietrich CF et al: Fasciolosis. Z Gastroenterol. 53(4):285-90, 2015
            4. Farrokh D et al: Hepatic alveolar echinococcosis. Arch Iran Med. 18(3):199-202, 2015
            5. Lu Q et al: Contrast-enhanced ultrasonographic findings of hepatic paragonimiasis. World J Gastroenterol. 19(13):2087-91, 2013
            6. Brunetti E et al: Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 114(1):1-16, 2010
            7. Brunetti E et al: Update on cystic hydatid disease. Curr Opin Infect Dis. 22(5):497-502, 2009
            8. McManus DP et al: Echinococcosis. Lancet. 362(9392):1295-304, 2003
            9. WHO Informal Working Group: International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop. 85(2):253-61, 2003
            Related Anatomy
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            Related Differential Diagnoses
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            References
            Tables

            Tables

            KEY FACTS

            • Terminology

              • IMAGING

                TERMINOLOGY

                • Parasitic Disease

                  • Echinococcosis: Parasitic disease of tapeworms of Echinococcus genus
                    • 2 main types
                      • Cystic echinococcosis, a.k.a. hydatid disease, is caused by infection with larval stage of Echinococcus granulosus
                      • Alveolar echinococcosis is disease caused by infection with larval stage of Echinococcus multilocularis
                  • Clonorchiasis and opisthorchiasis: Helminthic diseases caused by liver flukes Clonorchis sinensis, Opisthorchis felineus, and Opisthorchis viverrini, respectively, spreading thorough raw or undercooked fish, crabs, or crayfish
                    • Liver flukes infect liver, gallbladder, and bile duct in humans
                  • Fascioliasis: Parasitic infection typically caused by flukes Fasciola hepatica and Fasciola gigantica, spreading through raw watercress or other water plants contaminated with immature parasite larvae
                    • Immature larval flukes migrate through intestinal wall, abdominal cavity, and liver tissue, into bile ducts
                  • Paragonimiasis: Food-borne parasitic infection spreading through raw or undercooked freshwater crabs or crayfish infected with Paragonimus metacercariae
                  • Ascariasis: Caused by infection with Ascaris lumbricoides adult worm, which might migrate from small bowel into bile duct, gallbladder, &/or liver parenchyma

                • Hepatic Tuberculosis

                  • Hepatic tuberculosis (TB) is always associated with systematic dissemination of TB infection
                  • Often unrecognized and missed because of its relatively nonspecific clinical presentations

                IMAGING

                • US Findings

                  • CEUS Findings

                    • Differential Diagnosis

                      Selected References

                      1. Dietrich CF et al: Never seen before? Opisthorchiasis and clonorchiasis. Z Gastroenterol. 56(12):1513-1520, 2018
                      2. Dietrich CF et al: Ascariasis imaging: pictorial essay. Z Gastroenterol. 55(5):479-489, 2017
                      3. Dietrich CF et al: Fasciolosis. Z Gastroenterol. 53(4):285-90, 2015
                      4. Farrokh D et al: Hepatic alveolar echinococcosis. Arch Iran Med. 18(3):199-202, 2015
                      5. Lu Q et al: Contrast-enhanced ultrasonographic findings of hepatic paragonimiasis. World J Gastroenterol. 19(13):2087-91, 2013
                      6. Brunetti E et al: Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 114(1):1-16, 2010
                      7. Brunetti E et al: Update on cystic hydatid disease. Curr Opin Infect Dis. 22(5):497-502, 2009
                      8. McManus DP et al: Echinococcosis. Lancet. 362(9392):1295-304, 2003
                      9. WHO Informal Working Group: International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop. 85(2):253-61, 2003