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Table 2 Parasitosis and affected abdominal organs. Associated radiological, clinical, and laboratory findings

From: Parasitic diseases as a cause of acute abdominal pain: imaging findings

Disease type Imaging findings Clinical presentation Lab findings
Cystic echinococcosisa [2, 3, 19,20,21,22,23,24,25,26,27,28,29,30,31]
Liver Perihepatic rupture - Fluid collection through the course of cyst’s content
- Mural thickening of the bowel loops and fat tissue stranding adjacent to cyst contents
- Focal outward bulging, discontinuity of the cyst wall
RUQ or generalized abdominal pain, fever, nausea and vomiting, urticaria, and fatal anaphylaxis Leukocytosis, elevated CRP (C reactive protein), eosinophilia, increase in serum aspartate transaminase (AST) and alanine aminotransferase (ALT) levels
Biliary rupture - Structural deformity, loss of spherical shape of the cyst
- Dilatation of the intrahepatic bile ducts with linear filling defects within the biliary tract
- Lipid-fluid level due to bile
- Air or an air-fluid level within the cyst if superinfection is present
RUQ pain, jaundice, pruritus, fever, nausea and vomiting, anaphylactic reaction Leukocytosis, elevated CRP, eosinophilia, elevated serum AST, ALT, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, and amylase
Vascular invasion - Dilatation of the affected vein (most commonly hepatic veins)
- Total occlusion or linear filling defects within the lumen
- Parenchymal hemodynamic change at vascular territory
RUQ pain, dyspnea and chest pain in case of pulmonary embolism Leukocytosis, eosinophilia, abnormal liver function tests and, hypoxemia and hypocapnia/hypercapnia in case of pulmonary embolism
Biliary compression - Dilatation of the intrahepatic bile ducts without linear filling defects; however, increased echogenicity/decreased T2 signal could be seen due to within the biliary tract. Dilatation of the intrahepatic bile ducts, enhancement of intrahepatic biliary duct, parenchymal changes (increased signal intensity on T2-weighted images, segmental parenchymal enhancement) -RUQ, jaundice, pruritus
-Fever, nausea and vomiting less common compared to biliary rupture
Eosinophilia, elevated ALP, GGT, and bilirubin
Kidney Perirenal rupture - Fluid collection through the course of cyst’s content
- Focal outward bulging, discontinuity of the cyst wall
Flank pain, fever, nausea and vomiting, urticaria, and fatal anaphylaxis Leukocytosis, elevated CRP, eosinophilia, high serum blood urea nitrogen (BUN), and creatinine
Pelvicalyceal system rupture - Structural deformity, loss of spherical shape of the cyst
- Hydroureteronephrosis, pyonephrosis may accompany
- Filling defects within the pelvicalyceal system
- Urinoma may accompany in case of pelvicalyceal system rupture
Flank pain, fever, nausea and vomiting, urticaria, and fatal anaphylaxis
Pelvicalyceal system compression - Hydroureteronephrosis without filling defects
- Urinary dilatation is seen above the level of compression
Flank pain, fever, nausea and vomiting, urticaria, and fatal anaphylaxis Eosinophilia, elevated BUN, and creatinine
Fascioliasisa [2, 3, 32,33,34,35,36,37,38,39,40,41,42,43]
Liver Hepatic stage - Multiple microabscesses, “tunnels and caves” sign
- Subcapsular hemorrhage-effusion, focal liver capsule thickening and enhancement
- Periportal lymphadenopathy, rarely portal vein thrombosis and wedge-shaped hemorrhagic infarction
- Splenomegaly may accompany
RUQ pain, urticaria, right upper quadrant pain and fever, fatigue Leukocytosis, eosinophilia, elevated liver enzymes
Biliary stage - Dilated biliary ducts, periportal thickening
- Floating particles in the biliary system
- Cholecystitis and/or pancreatitis may accompany
RUQ pain, pain could be disseminated in case of pancreatitis, jaundice, fever, nausea, diarrhea, pruritus Leukocytosis, eosinophilia, elevated liver enzymes, hyperbilirubinemia, and elevated pancreatic enzymes in case of pancreatitis
Ascariasisa [2, 3, 44,45,46,47,48,49]
Gastrointestinal system (GIS) -Tubular structure within the lumen of stomach or bowel, associated fat tissue stranding
- Dilated bowels in case of intestinal obstruction
- Rarely, intraabdominal free fluid, gas, and/or fluid collection in case of GIS perforation
- Inflamed and distended appendix vermiformis
Abdominal distension, dyspepsia, nausea and vomiting in case of GIS obstruction, generalized abdominal pain fever and sepsis in case of GIS perforation, RLQ pain in case of acute appendicitis Anemia, leukocytosis, eosinophilia
Liver - Areas of decreased attenuation on CT, altered echogenicity on US due to parenchymal involvement
- Filling defects within the biliary tree or gallbladder
- Biliary dilatation, periportal inflammation
- Gallbladder wall thickening and distention
- Parenchymal or perihepatic abscess
RUQ pain, fatigue, fever, jaundice and pruritus in case of biliary dilatation, MURPHY sign positivity in case of acute cholecystitis, septic status can be seen in case of gallbladder perforation or liver abscess Anemia, leukocytosis, eosinophilia, and elevated liver tests including bilirubin
Pancreas - Thickening of pancreas, peripancreatic fat tissue stranding and fluid collection may accompany Epigastric pain and acute pancreatitis can be the sole presentation or be seen following biliary involvement Leukocytosis, eosinophilia, elevated pancreatic enzymes, mild hyperbilirubinemia, high ALP and GGT levels
Toxocariasisa [2, 46,47,48,49]
Liver - Multiple, ill-defined, oval shaped, small lesions (< 2 cm) in parenchyma
- Lesions may coalescence on follow-up
- Splenomegaly may accompany
RUQ pain, fatigue, fever, nausea and vomiting Leukocytosis, eosinophilia, mildly elevated liver enzymes
Taeniasisa [2, 18, 50,51,52,53,54,55,56]
Gastrointestinal system (GIS) -Tubular structure within the lumen of stomach or bowel, associated fat tissue stranding
- Dilated bowels in case of intestinal obstruction
- Rarely, intraabdominal free fluid, gas and/or fluid collection in case of GIS perforation
- Inflamed and distended appendix vermiformis
Abdominal distension, dyspepsia, nausea and vomiting in case of GIS obstruction, generalized abdominal pain fever and sepsis in case of GIS perforation, RLQ pain in case of acute appendicitis Leukocytosis, eosinophilia, anemia
Liver - Filling defects within the biliary tree or gallbladder
- Biliary dilatation, periportal inflammation
- Gallbladder wall thickening and distention
RUQ pain, fatigue, fever, jaundice and pruritus in case of biliary dilatation, MURPHY sign positivity in case of acute cholecystitis, septic status can be seen in case of gallbladder perforation Leukocytosis, eosinophilia, hyperbilirubinemia and elevated liver enzymes
Pancreas - Thickening of pancreas, peripancreatic fat tissue stranding and fluid collection may accompany Epigastric pain and acute pancreatitis can be the sole presentation or be seen following biliary involvement Leukocytosis, eosinophilia, elevated pancreatic and liver enzymes
Amoebiasisa [44, 57,58,59]
Colon - Colonic wall thickening, mucosal edema and increased mucosal enhancement (primarily ascending colon)
- Rarely, intraabdominal free fluid, gas and/or fluid collection in case of colonic perforation
Bloody diarrhea, tenesmus, fever, and abdominal pain.
Generalized abdominal pain and sepsis in case of colonic perforation
Leukocytosis, anemia
Liver - Parenchymal loculated fluid collection (abscess), air or an air-fluid level can be seen within the collection.
- Perihepatic fluid and right-sided pleural effusion may accompany
RUQ pain, fever, colonic symptoms may accompany, sepsis in case of diffuse liver abscesses Leukocytosis without eosinophilia, anemia, elevated liver enzymes, high erythrocyte sedimentation rate and CRP
Malariaa [14, 60,61,62,63,64,65,66]
Liver - Hepatomegaly, periportal edema, perihepatic or intraabdominal ascites
- Gallbladder wall thickening and distention due to acalculous cholecystitis
RUQ pain, fatigue and fever, MURPHY sign positivity in case of acute cholecystitis Anemia, thrombocytopenia, leukocytosis, mild hyperbilirubinemia, mildly elevated liver enzymes
Spleen - Areas of decreased attenuation on CT, altered echogenicity on US due to infarction, splenomegaly
- Parenchymal or perisplenic hemorrhage/hematoma in case of spontaneous splenic rupture
LUQ pain
Rapid clinical deterioration tachycardia and hemorrhagic shock in case of splenic rupture
Gastrointestinal system (GIS) - Dilated bowels in case of intestinal obstruction
- Rarely, intraabdominal free fluid, gas, and/or fluid collection in case of GIS perforation
Nausea and vomiting in case of GIS obstruction, generalized abdominal pain fever and sepsis in case of GIS perforation
Pancreas - Thickening of pancreas, peripancreatic fat tissue stranding and fluid collection may accompany Epigastric pain and symptoms related to acute pancreatitis Anemia, thrombocytopenia, leukocytosis, hyperbilirubinemia, elevated liver and pancreatic enzymes
Visceral leishmaniasisa [16, 67,68,69,70,71,72]
Liver - Hepatomegaly, ascites, right-sided pleural effusion
- Nodular shaped focal parenchymal lesions
RUQ pain, fatigue and fever, Pancytopenia, elevated CRP, hypergammaglobulinemia
Spleen - Splenomegaly, ascites, left sided pleural effusion
- Nodular shaped focal parenchymal lesions
- Parenchymal or perisplenic hemorrhage/hematoma in case of spontaneous splenic rupture
LUQ pain, fatigue and fever, rapid clinical deterioration tachycardia, and hemorrhagic shock in case of splenic rupture
Lymph nodes - Enlarged and heterogeneous lymph nodes, central cystic changes can be seen in case of necrosis Painful and palpable peripherally located lymphadenopathy
Dientamoebiasisa [17, 73]
Gastrointestinal system (GIS) - Bowel wall thickening, mucosal edema, associated intra-abdominal free fluid
- Dilated bowels in case of intestinal obstruction
Abdominal pain, diarrhea, anorexia Leukocytosis, rarely eosinophilia
Liver - Periportal fat tissue stranding and/or edema RUQ or epigastric pain, fever
Anisakiasisa [74,75,76,77]
Gastrointestinal system (GIS) - Severe submucosal edema of the involved gastrointestinal area, adjacent fat tissue stranding, enlargement of lymph nodes, intraabdominal free fluid may accompany. Rarely intestinal obstruction due to intussusception Abdominal pain, nausea, vomiting, diarrhea, signs of peritoneal irritation
Ileus/intestinal obstruction with or without intussusception
Leukocytosis
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