Ultrasonographic appearance of intestinal Ascaris
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ULTRASOUND IMAGE OF THE MONTH
Ultrasonographic appearance of intestinal Ascaris Taylan Kara
Received: 8 August 2012 / Accepted: 16 August 2012 / Published online: 3 October 2012 Ó The Japan Society of Ultrasonics in Medicine 2012
Keywords
Ascaris Ultrasonography Infestation
A ten-month-old boy was admitted to radiology department with vomiting and abdominal distension for the previous 3 days. The abdomen was distended and painful on physical examination. Ultrasonography (US) was performed. The small intestine segments were dilated and filled with food particles and fluid. US also showed a typical ‘‘target sign’’ in the lower right abdominal quadrant that represented ileocolic intussusception. Additionally, a long curvilinear structure with peristaltism located within the distal segment of the ileum was seen on US. Longitudinal scans of the structure demostrated two parallel echogenic bands with a central anechoic area (Fig. 1). The appearance was consistent with Ascaris lumbricoides.
Ascaris lumbricoides is one of the most common human helminth infestations. Although the most common location of Ascaris is the jejunum and proximal ileum, the worm may inhabit anywhere from the stomach to the ileocecal valve [1]. The characteristic appearances of Ascaris on US include parallel echogenic lines seperated by a hypoechoic area called the ‘‘triple-line sign’’ and a target-like appearance [2]. Sonographic features of Ascaris in the digestive tract also include pseudotumor appearance, serpentine movement, spaghetti-like appearance, rod-like appearance with echoic tubular central lines, curved strips, and rod-like appearance [3]. The appearance of Ascaris on US may be similar to that of feeding tubes, surgical drainage tubes, and ventriculoperitoneal shunts, and a differential diagnosis should be made [4].
Fig. 1 Ultrasonography shows a tubular structure with two parallel echogenic bands and a central anechoic area (arrows) indicating the body of Ascaris lumbricoides in the small bowel
T. Kara (&) Department of Radiology, Osmangazi University Medical Faculty, Eskisehir, Turkey e-mail: [email protected]
Although fecal parasitological examination is essential for diagnosis, real-time visualization of Ascaris on US is a quick, readily available, non-invasive, and inexpensive modality in the diagnosis of Ascaris. Because Ascaris has a characteristic sonographic appearance, increasing familiarity with the
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characteristic appearance of Ascaris will increase the rate of diagnosis. Conflict of interest
None.
References 1. Wani I, Rather M, Naikoo G, et al. Intestinal ascariasis in children. World J Surg. 2010;34:963–8.
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2. Mahmood SA, Lee EY. Intestinal Ascaris lumbricoides. Pediatr Radiol. 2010;40:1452. 3. Wu S. Sonographic findings of Ascaris lumbricoides in the gastrointestinal and biliary tracts. Ultrasound Q. 2009;25:207–9. 4. Mahmood T, Mansoor N, Quraishy S, et al. Ultrasonographic appearance of Ascaris lumbricoides in the small bowel. J Ultrasound Med. 2001;
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