Weiss D, Marti G, Mouton W, Wermke W, Kummer O
Medizinische Klinik, Spital STSAG, Thun, Schweiz.
Ultraschall Med. 2010 Apr;31(2):175-81. doi: 10.1055/s-0029-1245188. Epub 2010 Feb 24.
Described are the clinical and, especially, the contrast-enhanced ultrasonographic presentation and recovery of four cases of fascioliasis occurring between December 2008 and February 2009.
A detailed history, clinical examination and laboratory investigation were followed by contrast-enhanced ultrasonography of the liver and serological evidence for the presence of antibodies. A final contrast-enhanced ultrasound was performed 6 weeks after treatment with triclabendazole.
The patients displayed a variety of symptoms ranging from vasospastic myocardial infarction diagnosed via coronary angiography and a first-time occurrence of migraine as a result of hypereosinophilia to fever with weight loss and tumor-like liver lesions. The contrast-enhanced ultrasonographic hepatic changes in fascioliasis are characterized by segmental arterial hyperemia with emphasis on the liver periphery and subcapsular canalicular sparing corresponding to parenchymal necrosis and hemorrhage. In the later phases areas with inflammatory changes were unmasked due to phlebitis of the small portal vessels and granulomatous parenchymal changes. All four patients were successfully treated with triclabendazole without experiencing any serious side effects.
Contrast-enhanced ultrasonography is well suited for the diagnosis and monitoring of hepatic fascioliasis.
描述2008年12月至2009年2月期间发生的4例肝片吸虫病患者的临床情况，尤其是超声造影表现及恢复情况。
详细询问病史、进行临床检查及实验室检查，之后对肝脏进行超声造影检查，并检测抗体的血清学证据。用三氯苯达唑治疗6周后进行最后一次超声造影检查。
患者表现出多种症状，从经冠状动脉造影诊断的血管痉挛性心肌梗死、因嗜酸性粒细胞增多首次出现偏头痛到发热伴体重减轻及肝脏肿瘤样病变。肝片吸虫病的超声造影肝脏改变特征为节段性动脉充血，以肝周边部为主，包膜下胆小管未受累，对应实质坏死和出血。在后期，由于小门静脉静脉炎和实质肉芽肿性改变，炎症改变区域显现出来。所有4例患者均成功接受三氯苯达唑治疗，未出现任何严重副作用。
超声造影非常适合肝片吸虫病的诊断和监测。
