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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Filariasis presenting as acute abdominal pain: The role of imaging and image-guided intervention in diagnosis</title><author><name sortKey="Metha, Natasha N" sort="Metha, Natasha N" uniqKey="Metha N" first="Natasha N." last="Metha">Natasha N. Metha</name><affiliation><nlm:aff id="aff1">consulting radiologists, Dot 3D Scanning Centre, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</nlm:aff></affiliation></author><author><name sortKey="Dalavi, Vashali S" sort="Dalavi, Vashali S" uniqKey="Dalavi V" first="Vashali S." last="Dalavi">Vashali S. Dalavi</name><affiliation><nlm:aff id="aff2">senior resident, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</nlm:aff></affiliation></author><author><name sortKey="Mehta, Nikit P" sort="Mehta, Nikit P" uniqKey="Mehta N" first="Nikit P." last="Mehta">Nikit P. Mehta</name><affiliation><nlm:aff id="aff1">consulting radiologists, Dot 3D Scanning Centre, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27398130</idno><idno type="pmc">4921166</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921166</idno><idno type="RBID">PMC:4921166</idno><idno type="doi">10.2484/rcr.v10i2.1125</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002387</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002387</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Filariasis presenting as acute abdominal pain: The role of imaging and image-guided intervention in diagnosis</title><author><name sortKey="Metha, Natasha N" sort="Metha, Natasha N" uniqKey="Metha N" first="Natasha N." last="Metha">Natasha N. Metha</name><affiliation><nlm:aff id="aff1">consulting radiologists, Dot 3D Scanning Centre, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</nlm:aff></affiliation></author><author><name sortKey="Dalavi, Vashali S" sort="Dalavi, Vashali S" uniqKey="Dalavi V" first="Vashali S." last="Dalavi">Vashali S. Dalavi</name><affiliation><nlm:aff id="aff2">senior resident, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</nlm:aff></affiliation></author><author><name sortKey="Mehta, Nikit P" sort="Mehta, Nikit P" uniqKey="Mehta N" first="Nikit P." last="Mehta">Nikit P. Mehta</name><affiliation><nlm:aff id="aff1">consulting radiologists, Dot 3D Scanning Centre, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</nlm:aff></affiliation></author></analytic><series><title level="j">Radiology Case Reports</title><idno type="eISSN">1930-0433</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Filariasis is an endemic infection seen in tropical and subtropical regions of the world that presents with lymphatic dysfunction in the form of lymphocoele, hydrocoele, chyluria, or groin lymphadenovarix. We report a case of filariasis with the unusual presentation of acute abdominal pain in which radiographic imaging modalities played a crucial role in diagnosis.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Szuba, A" uniqKey="Szuba A">A Szuba</name></author><author><name sortKey="Rockson, Sg" uniqKey="Rockson S">SG Rockson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fauci, As" uniqKey="Fauci A">AS Fauci</name></author><author><name sortKey="Braunwald, E" uniqKey="Braunwald E">E Braunwald</name></author><author><name sortKey="Isselbacher, Kj" uniqKey="Isselbacher K">KJ Isselbacher</name></author><author><name sortKey="Wilson, Jd" uniqKey="Wilson J">JD Wilson</name></author><author><name sortKey="Martin, Jb" uniqKey="Martin J">JB Martin</name></author><author><name sortKey="Kasper, Dl" uniqKey="Kasper D">DL Kasper</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahn, Pj" uniqKey="Ahn P">PJ Ahn</name></author><author><name sortKey="Bertagnolli, R" uniqKey="Bertagnolli R">R Bertagnolli</name></author><author><name sortKey="Fraser, Sl" uniqKey="Fraser S">SL Fraser</name></author><author><name sortKey="Freeman, Jh" uniqKey="Freeman J">JH Freeman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vettoretto, N" uniqKey="Vettoretto N">N Vettoretto</name></author><author><name sortKey="Odeh, M" uniqKey="Odeh M">M Odeh</name></author><author><name sortKey="Romessis, M" uniqKey="Romessis M">M Romessis</name></author><author><name sortKey="Pettinato, G" uniqKey="Pettinato G">G Pettinato</name></author><author><name sortKey="Taglietti, L" uniqKey="Taglietti L">L Taglietti</name></author><author><name sortKey="Giovanetti, M" uniqKey="Giovanetti M">M Giovanetti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Ek" uniqKey="Smith E">EK Smith</name></author><author><name sortKey="Ek, E" uniqKey="Ek E">E Ek</name></author><author><name sortKey="Croagh, D" uniqKey="Croagh D">D Croagh</name></author><author><name sortKey="Spain, La" uniqKey="Spain L">LA Spain</name></author><author><name sortKey="Farrell, S" uniqKey="Farrell S">S Farrell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kapoor, Ak" uniqKey="Kapoor A">AK Kapoor</name></author><author><name sortKey="Puri, Sk" uniqKey="Puri S">SK Puri</name></author><author><name sortKey="Arora, A" uniqKey="Arora A">A Arora</name></author><author><name sortKey="Upreti, L" uniqKey="Upreti L">L Upreti</name></author><author><name sortKey="Puri, As" uniqKey="Puri A">AS Puri</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Radiol Case Rep</journal-id><journal-id journal-id-type="iso-abbrev">Radiol Case Rep</journal-id><journal-title-group><journal-title>Radiology Case Reports</journal-title></journal-title-group><issn pub-type="epub">1930-0433</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27398130</article-id><article-id pub-id-type="pmc">4921166</article-id><article-id pub-id-type="publisher-id">S1930-0433(16)30040-1</article-id><article-id pub-id-type="doi">10.2484/rcr.v10i2.1125</article-id><article-id pub-id-type="publisher-id">1125</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Filariasis presenting as acute abdominal pain: The role of imaging and image-guided intervention in diagnosis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Metha</surname><given-names>Natasha N.</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Dalavi</surname><given-names>Vashali S.</given-names></name><degrees>MD</degrees><email>vaishusd31@gmail.com</email><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Mehta</surname><given-names>Nikit P.</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib></contrib-group><aff id="aff1"><label>a</label>consulting radiologists, Dot 3D Scanning Centre, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</aff><aff id="aff2"><label>b</label>senior resident, Department of Radiology, Government Medical College, Sangli, Maharahtra, India</aff><pub-date pub-type="pmc-release"><day>17</day><month>2</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>17</day><month>2</month><year>2016</year></pub-date><volume>10</volume><issue>2</issue><elocation-id>1125</elocation-id><permissions><copyright-statement>© 2015 The Authors.</copyright-statement><copyright-year>2015</copyright-year><license license-type="CC BY-NC-ND" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).</license-p></license></permissions><abstract id="ceab10"><p>Filariasis is an endemic infection seen in tropical and subtropical regions of the world that presents with lymphatic dysfunction in the form of lymphocoele, hydrocoele, chyluria, or groin lymphadenovarix. We report a case of filariasis with the unusual presentation of acute abdominal pain in which radiographic imaging modalities played a crucial role in diagnosis.</p></abstract></article-meta></front><body><sec id="cesec10"><title>Introduction</title><p>Filarial infections are common in tropical and subtropical geographic regions. Lymphatic filariasis is caused by <italic>Wucheria bancrofti</italic>, <italic>Brugia malaria</italic>, or <italic>Brugia timori</italic>. These are threadlike worms that reside in the lymphatic channels; clinical manifestations are related to lymphatic occlusion that causes lymphagiectasia (<xref rid="bib1" ref-type="bibr">1</xref>). The most common presentations of lymphatic filariasis are subclinical microfilaremia, hydrocoele, acute adeno-lymphangitis. and chronic lymphatic disease (<xref rid="bib2" ref-type="bibr">2</xref>). We report a unusual presentation of filariasis as an acute abdominal condition in which the diagnosis was made with help of ultrasonography (US), CT, and the demonstration of filarial larvae in fluid aspirated under ultrasound guidance.</p></sec><sec id="cesec20"><title>Case Report</title><p>An 18-year-old male presented with a complaint of acute, right-sided, abdominal pain. He had a history of low-grade fever and vomiting. Physical examination did not reveal any significant abnormality except for diffuse abdominal tenderness.</p><p>A complete blood count showed no abnormality; total leukocyte count and differential count was normal (eosinophils = 1%). US revealed dilated tubular cystic channels in the pelvis and complex, ill-defined cystic masses in the bilateral inguinal regions (<xref rid="fig1" ref-type="fig">Fig. 1</xref>). Mild enlargement of the liver and spleen was also noted. The patient was referred for a CT scan for further evaluation.</p><p>CT of the abdomen revealed gross, diffuse, retroperitoneal edema with multiple small tubular hypodensities causing compression of the blood vessels and the bladder wall (<xref rid="fig2" ref-type="fig">Figs. 2A, B</xref>). In addition, multiple enlarged para-aortic and mesenteric lymph nodes were seen. We made a provisional diagnosis of thoracic duct obstruction with gross lymphedema and lymphangiectasia.</p><p>US-guided diagnostic aspiration of fluid from the cystic lesions in the inguinal region was performed. During the workup, we obtained a history of mild scrotal swelling. High-resolution US of the scrotum revealed scrotal wall fluid with significantly mobile linear echogenic structures in it (filarial dance).</p><p>US-guided aspiration of the scrotal wall fluid was also performed (<xref rid="fig3" ref-type="fig">Fig. 3</xref>). The study of fluid aspirated from the inguinal lesion and scrotal wall revealed motile larvae of <italic>Wucheria bancrofti</italic>, and this confirmed the diagnosis.</p><p>The patient was given 100 mg of oral Hetrazan (Diethyl carbamazepine) three times a day. In addition, injectable analgesics, antibiotics, and steroids were prescribed. Antifilarial treatment was continued for three weeks, after which the patient showed good symptomatic response.</p></sec><sec id="cesec30"><title>Discussion</title><p>Abdominal filariasis presenting as an acute abdominal condition is very rarely seen. We have come across only one case, presenting as acute lower abdominal and groin pain (<xref rid="bib3" ref-type="bibr">3</xref>). A few other cases that presented with acute chylous peritonitis due to lymphatic occlusion were of nonfilarial origin (<xref rid="bib4" ref-type="bibr">4</xref>, <xref rid="bib5" ref-type="bibr">5</xref>).</p><p>In the workup of patients with acute abdomen discomfort. many possibilities must be considered, and they can be ruled out with the help of different investigations. In this case, though the clinical picture indicated an acute condition, blood examination (including the total WBC count, differential count, and serum amylase level) was normal.</p><p>US and CT scans of the abdomen demonstrated retroperitoneal lymphedema and lymphangiectasia. The CT imaging features of diffuse lymphangiectasia caused by filariasis have been described (<xref rid="bib3" ref-type="bibr">3</xref>). In spite of this, the diagnosis can be confirmed only by the presence of filarial parasites in the fluid aspirated from cystic lesions (<xref rid="bib6" ref-type="bibr">6</xref>).</p><p>Thus, though correlation of clinical and hematological examination are thought to be required to reach a conclusion in a patient with an acute abdomen, in our case diagnosis was solely made with the help of imaging modalities (that is, US and CT) and a demonstration of filarial parasites in cyst fluid aspirated under ultrasound guidance.</p></sec><sec id="cesec40"><title>Conclusion</title><p>The report highlights the role of imaging modalities (US and CT) in clinical practice. More importantly, we have demonstrated that filariasis can be a cause of acute abdominal pain. A timely image-guided aspiration of cyst fluid, and demonstration of filarial parasites in it, confirmed the diagnosis at an early stage. Because of this, the patient was placed on antifilarial drugs and has shown a significant reduction of symptoms.</p></sec></body><back><ref-list><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sbref10"><person-group person-group-type="author"><name><surname>Szuba</surname><given-names>A</given-names></name><name><surname>Rockson</surname><given-names>SG</given-names></name></person-group><article-title>Lymphedema: Classification, diagnosis and therapy</article-title><source>Vascular Med</source><volume>3</volume><year>1998</year><fpage>45</fpage><lpage>56</lpage><ext-link ext-link-type="uri" xlink:href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9796078&query_hl=9&itool=pubmed_docsum" id="interrefs10">[PubMed]</ext-link></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="book" id="sbref20"><person-group person-group-type="author"><name><surname>Fauci</surname><given-names>AS</given-names></name><name><surname>Braunwald</surname><given-names>E</given-names></name><name><surname>Isselbacher</surname><given-names>KJ</given-names></name><name><surname>Wilson</surname><given-names>JD</given-names></name><name><surname>Martin</surname><given-names>JB</given-names></name><name><surname>Kasper</surname><given-names>DL</given-names></name></person-group><source>Harrison's Principles of Internal Medicine</source><edition>15th ed.</edition><year>2001</year><publisher-name>McGraw Hill</publisher-name><publisher-loc>New York</publisher-loc><fpage>1238</fpage></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="journal" id="sbref30"><person-group person-group-type="author"><name><surname>Ahn</surname><given-names>PJ</given-names></name><name><surname>Bertagnolli</surname><given-names>R</given-names></name><name><surname>Fraser</surname><given-names>SL</given-names></name><name><surname>Freeman</surname><given-names>JH</given-names></name></person-group><article-title>2005. 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Case report and literature review</article-title><source>Eur Surg Res</source><volume>41</volume><year>2008</year><fpage>54</fpage><lpage>57</lpage><ext-link ext-link-type="uri" xlink:href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18460870&query_hl=9&itool=pubmed_docsum" id="interrefs30">[PubMed]</ext-link><pub-id pub-id-type="pmid">18460870</pub-id></element-citation></ref><ref id="bib5"><label>5</label><element-citation publication-type="journal" id="sbref50"><person-group person-group-type="author"><name><surname>Smith</surname><given-names>EK</given-names></name><name><surname>Ek</surname><given-names>E</given-names></name><name><surname>Croagh</surname><given-names>D</given-names></name><name><surname>Spain</surname><given-names>LA</given-names></name><name><surname>Farrell</surname><given-names>S</given-names></name></person-group><article-title>Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis</article-title><source>World J Gastroenterol</source><volume>15</volume><year>2009</year><fpage>4849</fpage><lpage>4852</lpage><ext-link ext-link-type="uri" xlink:href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=19824123&query_hl=9&itool=pubmed_docsum" id="interrefs40">[PubMed]</ext-link><pub-id pub-id-type="pmid">19824123</pub-id></element-citation></ref><ref id="bib6"><label>6</label><element-citation publication-type="journal" id="sbref60"><person-group person-group-type="author"><name><surname>Kapoor</surname><given-names>AK</given-names></name><name><surname>Puri</surname><given-names>SK</given-names></name><name><surname>Arora</surname><given-names>A</given-names></name><name><surname>Upreti</surname><given-names>L</given-names></name><name><surname>Puri</surname><given-names>AS</given-names></name></person-group><article-title>Filariasis presenting as intraadominal cyst</article-title><source>Indian Journal of Radiol Imaging</source><volume>21</volume><issue>1</issue><year>2011 Jan</year><fpage>18</fpage><lpage>20</lpage><ext-link ext-link-type="uri" xlink:href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=21431027&query_hl=9&itool=pubmed_docsum" id="interrefs50">[PubMed]</ext-link></element-citation></ref></ref-list></back><floats-group><fig id="fig1"><label>Fig. 1</label><caption><p>Transverse ultrasound images of the bilateral inguinal regions (A] and scrotal wall (B) show dilated lymphatic channels as multiple cystic spaces.</p></caption><graphic xlink:href="gr1"></graphic></fig><fig id="fig2"><label>Fig. 2</label><caption><p>Transverse, contrast-enhanced CT images of the abdomen at the level of the right kidney (A) and bilateral iliac regions (B) show diffuse retroperitoneal soft-tissue hypodensity encasing the vessels and extending down to the pelvis and inguinal regions.</p></caption><graphic xlink:href="gr2"></graphic></fig><fig id="fig3"><label>Fig. 3</label><caption><p>US-guided aspiration of fluid from the scrotal wall.</p></caption><graphic xlink:href="gr3"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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