Hepatic granulomas due to visceral larva migrans in adults: Appearance on US and MRI

Abstract

Visceral larva migrans is a syndrome characteristically involving children with a history of pica, and usually presents with fever, abdominal pain, tender hepatomegaly, and hypereosinophilia. Hepatic granulomas of visceral larva migrans are rare in adults. We describe three adult patients with hepatic lesions which on histopathology demonstrated characteristic granulomas of visceral larva migrans. All patients had abdominal sonograms and two had additional MR scans of the liver. Both ultrasound and magnetic resonance imaging demonstrated characteristic appearances which have not been described previously (viz., ill-defined central necrotic areas surrounded by concentric thick walls and perifocal edema in the liver parenchyma).

Hepatic imaging studies on patients with visceral larva migrans due to probable Ascaris suum infection

“…Only two papers describing MRI findings in patients with VLM caused by T. canis have been published to date [3,14]. In our patients 1 and 3, the hepatic mass lesions were detected as high-intensity areas on T2-weighted MRI, similar to the patients reported by Ishibashi et al [3] and Jain et al [14].…”

“…The findings of hepatic imagings in patients with VLM due to A. suum have not been described previously. However, those due to Toxisocaria such as T. canis and T. cati have been repeatedly reported [3,4,6,13,14]. Thus, we compared the characteristics of hepatic imagings in our patients with those of toxocarosis.…”

“…However, Jain et al reported the presence of heterogeneous mass lesions in a patient with VLM on noncontrast CT [14]. Ishibashi et al [3] reported that undetectable mass lesions with noncontrast CT were detectable in the delayed phase on contrast CT.…”

“…Lesions with multiple small hypoechoic areas [3,6], concentric rings like hyperechoic walls [14], and multiple small hyperechoic areas [13] are characteristic US findings in patients with Toxocara. Bhatia and Sarin reported that their ultrasonographic findings changed from hypoechoic mass lesions to lesions with hyperechoic rims as the disease advanced [4].…”

Toxocariasis: visceral larva migrans in children

“…A partir de 1992, foram relatados casos isolados em adultos de comprometimento hepático com teste sorológico positivo para T. canis 78,98,99 . Porém, até 1994, houve casos relatados na literatura de alterações hepáticas ao ultrassom em crianças com anticorpo anti-Toxocara ELISA positivo 79 77 .…”