Parasites and Biliary stones

Fascioliasis ١٦
can demonstrate peripheral tortuous lesions of the liver diagnostic of
hepatic fascioliasis (Miguel et al., 1984).
The image seen on ultrasound and CT is sometimes confused with
malignancy or stones and appear in CT as subcapsular hypodense lesions
(figure 4) (Dias et al., 1996). In the diagnosis of this disease, ultrasound
may not provide certain information and CT is not superior. The most
useful diagnostic test for viewing the bile ducts is cholangiography by
ERCP, and more recently, by magnetic resonance
cholangiopancreatograpy (MRCP) (Pantangco and Sahota, 2004). Some
technical limitations make bile duct detail obtained by ultrasound, CT or
MRCP imaging methods inferior to that obtained with ERCP. For this
reason, ERCP is considered to be the gold standard for bile duct imaging
(Suhocki, 2004). ERCP should also be considered the first choice in
patients in the chronic phase, even if the diagnosis is established by
ultrasound or CT (Dowidar et al., 1999).
Figure (3): The appearance of Fasciola hepatica fluke on ultrasonographic
examination of the gallbladder. During ultrasonography movements of the fluke can
be demonstrated (quoted from Osman et al., 1998).