Fascioliasis simulating an intrahepatic cholangiocarcinoma-Case report with imaging and pathology correlation
Héctor Losada1, Michael Hirsch1, Pablo Guzmán1
11 Cirugía Hepato-pancreática y Biliar, Departamento de Cirugía y Traumatología, Universidad de La Frontera, Temuco, Chile ; 2 Cirugía Hepato-pancreática y Biliar, Departamento de Cirugía, Clínica Alemana de Temuco, Temuco, Chile ; 3 Departamento de Imágenes Clínica Alemana de Temuco, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Temuco, Chile ; 4 Departamento de Patología, Universidad de La Frontera, Temuco, Chile ; 5 Laboratorio de Inmunoparasitología Molecular CEGIN, Departamento de Ciencias Preclínicas, Universidad de La Frontera, Temuco, Chile ; 6 Departamento de Medicina Interna, Universidad de La Frontera, Temuco, Chile ; 7 Servicio de Gastroenterología, Clínica Alemana de Temuco, Temuco, Chile.
Abstract:
Human fascioliasis is a rare zoonosis in Chile. Clinically it presents with a highly polymorphous group of symptoms that evolve in two periods. The first, acute or a result of hepatic invasion, lasts 2 weeks to 4 months and is characterized essentially by pain in the right hypochondrium and/or epigastrium, continuous fever and painful hepatomegaly. This clinical picture, associated with eosinophilia and a history of raw watercress consumption, corresponds to the classic presentation of the disease in its initial stage. We report the case of a 57-year-old female patient with no risk factors for and no clinical signs of fascioliasis, with a lesion in the right hepatic lobe compatible with intrahepatic cholangiocarcinoma, studied with computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET-CT). With the clinical suspicion of intrahepatic cholangiocarcinoma, a regulated right hepatectomy was performed, the pathological study of which revealed cholangitis and granulomatous pericholangitis resulting from trematode eggs, compatible with Fasciola hepatica.
