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 | |
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 | |
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 | |
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 | |
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 | |
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 | |
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 | |
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 | ||
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 | ||
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 | |