Intestinal giardiasis: the importance of serial filming

Intestinal giardiasis is a common enteric pathogen. Conventional diagnostic screening studies are only 50% accurate. Although radiologic abnormalities in the small intestine have been described, barium studies are often normal. Symptoms may be chronic and debilitating but are effectively treated with appropriate therapy. Three cases were encountered in which recognition of subtle radiographic abnormalities in the small intestine was responsible for proper diagnosis. These findings consisted of a progression from relatively normal jejunum on initial films to dilution, segmentation, and apparent increased fold thickness in the proximal small intestine on delayed films. When this pattern is identified, the radiologist may suggest the possibility of giardiasis and thus direct the referring physician to use definitive diagnostic procedures.