Investig Magn Reson Imaging.  2018 Jun;22(2):113-118. 10.13104/imri.2018.22.2.113.

Hepatic Toxocariasis with Atypical CT and MR Imaging Findings: a Case Report

• Shin HS
• Shin KS
• Lee JE
• Min JH
• You SK
• Shin BS

• KMID: 2415890
• DOI: http://doi.org/10.13104/imri.2018.22.2.113

Abstract

Hepatic toxocariasis is a type of visceral larva migrans caused by the migration of second-stage larvae of certain nematodes such as Toxocara canis to the liver. Histologically, the condition is characterized by granulomatous lesions containing eosinophils and inflammatory cells. We report a case of hepatic toxocariasis with atypical clinical and radiologic findings presenting as distinct, solitary hepatic nodule detected in a middle-aged woman.

Keyword

Hepatic visceral larva migrans; Toxocariasis; Toxocara canis

MeSH Terms

Eosinophils
Female
Humans
Larva
Larva Migrans, Visceral
Liver
Magnetic Resonance Imaging*
Toxocara canis
Toxocariasis*

Figure

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  Fig. 1 Hepatic toxocariasis in a 59-year-old woman, CT findings. Contrast-enhanced abdominal CT at the level of the hepatic dome displays a tiny, relatively well-defined nodular lesion (arrow) with possible peripheral enhancement.

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  Fig. 2 Hepatic toxocariasis in a 59-year-old woman, MRI findings. (a) T1-weighted axial MR image shows a tiny, faintly hypointense nodule. (b) T2-weighted axial MR image shows a tiny, distinct nodule with bright signal intensity. (c) Diffusion-weighted image with a b value of 800 shows a hyperintense nodule. (d) The corresponding lesion is hypointense on the ADC map, representing diffusion restriction. (e-g) Gadolinium-enhanced T1-weighted images show a hypointense nodule with significant rim enhancement in the arterial phase (e) and with insignificant rim enhancement in the portal venous (f) and equilibrium (g) phases. (h) The hepatobiliary phase image shows hypointense nodule without rim enhancement. The arrow indicates the lesion in each image.

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  Fig. 3 Follow-up CT (6 months later). 2-phase abdominal CT image in the portal venous phase reveals a round, well-defined nodule (arrow) 1.5 cm in size with an attenuation of 31 Hounsfield unit.

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  Fig. 4 Hepatic toxocariasis in a 59-year-old woman, ultrasound findings. Ultrasound of the liver shows a round, slightly hypoechoic nodule (arrow) on the right hepatic dome.

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  Fig. 5 Hepatic toxocariasis in a 59-year-old woman, microscopic findings. Photomicrograph (Hematoxylin & Eosin, × 40) reveals hepatocyte necrosis (N) surrounded by a granulomatous inflammatory reaction consisting predominantly of eosinophils (arrowheads) and a multinucleated giant cell (arrow), suggestive of parasitic infection. The remnants of Toxocara canis larvae were not identified.

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  Fig. 6 Follow-up CT (2.5 years later). Two and a half years after treatment for Toxocara canis infection was begun, 3-phase abdominal dynamic CT image in the portal venous phase reveals a 1.0-cm lesion (arrow), which had decreased size from 1.5 cm at the beginning of treatment. The lesion's position has no changed, nor are there any new hepatic lesions.

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