Rice-grain calcifications of cysticercosis
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CLASSICS IN ABDOMINAL RADIOLOGY
Rice‑grain calcifications of cysticercosis Pankaj Nepal1 · Vijayanadh Ojili2 Received: 29 July 2020 / Revised: 3 September 2020 / Accepted: 10 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Cysticercosis is a parasite disease, resulting from infection caused by encysted larval form of the tapeworm Taenia solium. Cysticercus develops in human, following ingestion of T. solium eggs through contaminated water and vegetables. It is the most common parasitic infection of the human nervous system and the most common cause of acquired seizures in the developing world. Absolute diagnosis can be made by direct histologic demonstration of the parasite on biopsy or fundoscopic examination, or visualization of scolex within the cyst on CT or MRI [1, 2]. Several other major and minor criteria also exist relying on highly suggestive neuroimaging features, positive serum antibodies, and resolution of cystic lesions after albendazole or praziquantel therapy [1]. Epidemiological information is also crucial; however, increased travel and immigration has led to increased incidence of cysticercosis in developed world, such as United States [1]. Cysticercosis is almost exclusively seen in the central nervous system (neurocysticercosis) with occasional simultaneous ocular involvement; however, rare cases of disseminated cysticercosis, as well as isolated muscular disease (myocysticercosis) also have been reported [1–4]. The cysticercus larvae spread from the intestines and get deposited in soft tissues and skeletal muscles of extremities, abdominal and chest wall. The rice-grain calcification is characteristic of T. solium infection which is formed after host inflammatory response kills the larval cyst, which undergoes granulomatous reaction and eventually calcifies [1–3]. These calcifications are not intra-abdominal, but
rather intramuscular, and may be encountered on various abdominal imaging modalities. This characteristic rice-grain appearance is because the larva gets deposited along the long axis of the muscle [4] (Figs. 1, 2). Clinically rice-grain calcifications manifest as sub-centimeter, firm, non-tender, soft tissue nodules, which may be palpable. A few differentials for scattered abdominal calcifications in adults include metastatic calcifications in uremia or hyperparathyroidism, dystrophic calcifications, lymph nodal calcifications seen with tuberculosis or fungal infection, calcified injection granulomas, and calcified peritoneal carcinomatosis [5]. The calcifications represent dead parasites and no further treatment is necessary, however, useful for diagnosis of disseminated disease. Demonstration of rice-grain calcifications on plain radiograph is also considered as a minor diagnostic criterion for neurocysticercosis by some authors [1, 2]. Presence of rice-grain calcifications may support to distinguish neurocysticercosis from its closest differential, tuberculosis, especially in endemic regions.
* Vijayanadh Ojili [email protected] Pankaj Nepal
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