Subcutaneous and musculoskeletal sparganosis: imaging characteristics and pathologic correlation

Distant migration of gel filler: imaging findings following breast augmentation

Recently, many attempts have been made to use injectable materials in the subcutaneous fat layer anywhere in the body, including the breast and face, for cosmetic purposes. A 56-year-old woman presented with multiple palpable lumps without tenderness or skin color changes on the anterior and lateral chest and the abdominal walls. Magnetic resonance imaging showed fluid-like collections without surrounding soft tissue inflammatory changes in the chest wall, abdominal wall, and deeper within the abdomen. The lesions penetrated the peritoneum and were observed adjacent to the liver dome. Ultrasonography also showed hypoechogenicity suggestive of fluid collection in the left axilla and trunk. The differential diagnosis based on radiologic findings included parasite manifestation, non-specific inflammatory conditions, and chronic granulomatous infections such as tuberculosis or non-tuberculous mycobacterial infections. However, these conditions are usually accompanied by changes in the adjacent subcutaneous fat layers, but our patient did not show any other abnormalities in the adjacent soft tissue. After biopsy and aspiration analysis, the patient was found to have a history of filler injection for breast augmentation approximately 17 years prior. It is often difficult to make a differential diagnosis without detailed knowledge of the patient's medical history. Here we describe a rare case of distant migration of the filler to the axilla, chest wall, abdominal wall, and peritoneum following breast augmentation with filler injection. Knowledge of the radiologic characteristics and migration patterns of gel fillers and their related complications is useful for making an accurate diagnosis.

A case of breast sparganosis: with an emphasis on ultrasonographic findings

Sparganosis is a rare disease caused by the infestation of the plerocercoid tapeworm larva of the genus Spirometra. Human sparganosis is most commonly encountered in subcutaneous fat areas of the abdomen, limbs, and genitourinary tract. Breast sparganosis occur very rarely, accounting for less than 2% of total human sparganosis cases. Because of the disease's rarity, clinical suspicion is essential to reach the diagnosis of breast sparganosis. We present a case of mammary sparganosis in a 58 year-old woman on the ultrasonographic findings. The patient had a painless breast lump with a history of drinking impure water. On ultrasonography (US), we noted four masses, the largest lesion was suspected as sparganosis, and others tended to be benign lesions. The patient was treated following excisions by a US guided Vacuum-assisted breast biopsy system (VABB). The final diagnosis of all lesions was sparganosis.

Lesionectomy for cerebral sparganosis and concomitant epilepsy: A case series of 15 patients

OBJECTIVE

To report the clinical characteristics and surgical outcomes of patients with cerebral sparganosis and concomitant epilepsy.

METHODS

We retrospectively collected the clinical data of all patients with cerebral sparganosis and concomitant epilepsy who underwent lesionectomy as treatment at Xiangya Hospital, Central South University between January 2015 and August 2019. Seizure outcomes were evaluated according to the International League Against Epilepsy (ILAE) classification. ILAE classes 1 and 2 were defined as favorable seizure outcomes, whereas ILAE classes 3-6 were defined as unfavorable seizure outcomes.

RESULTS

Fifteen patients with cerebral sparganosis and concomitant epilepsy who underwent lesionectomy as treatment met the inclusion criteria. Live worms were surgical removed in 80 % of patients. With a mean follow-up of 2.4 ± 1.1 years, 66.7 % of patients demonstrated favorable seizure outcomes, with improvement of symptoms other than seizures. Longer seizure duration associated with unfavorable seizure outcomes.

CONCLUSIONS

Lesionectomy is an effective treatment for patients with cerebral sparganosis and concomitant epilepsy. Early surgical treatment may offer more benefits to such patients.

Systemic diseases affecting the breast: Imaging, diagnosis, and management

Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.

Apparent Sparganosis Presenting as a Palpable Neck Mass: A Case Report and Review of Literature

Sparganosis is an uncommon human parasitic infection caused by plerocercoid cysts of the genus Spirometra. Sparganosis of the neck is a rare condition, thus making it difficult to diagnose. It is often initially misdiagnosed as a lymphadenopathy or a soft tissue tumor. Herein, we describe a rare case of apparent sparganosis presenting as a palpable mass in the left neck of a 53-year-old female patient. Imaging studies played a key role in the diagnosis. In this case report, we emphasize that sparganosis should be considered in the differential diagnosis of a palpable superficial mass. We also stress the importance of meticulous radiological review in the context of appropriate clinical suspicion.

Cerebral sparganosis presenting with atypical postcontrast magnetic resonance imaging findings: a case report and literature review

Background

Sparganosis, a rare and severe parasitic infection caused by the larvae of Spirometra species or simply sparganum, generally involves subcutaneous tissue or muscle. But occasionally, sparganum can also invade the human brain, resulting in cerebral sparganosis.

Case presentation

A 33-year-old woman presented with a 10-day history of headache. Postcontrast magnetic resonance imaging (MRI) revealed an irregular lesion with enhancement and the tunnel-shaped focus extending to the contralateral hemiphere. Cerebrospinal fluid (CSF) analysis disclosed pleocytosis (166 cells/μL) and an elevated protein concentration (0.742 g/L). Enzyme-linked immunosorbent assay (ELISA) revealed positive sparganum-specific antibody in both blood and CSF. Finally, the diagnosis of cerebral sparganosis was comfirmed. She received praziquantel treatment and got a favorable outcome during six-month follow-up.

Conclusions

Irregular enhancement and the tunnel sign that extends to the contralateral hemisphere on postconstrast MRI are unusual presentations of cerebral sparganosis. ELISA for sparganum-specific antibody can help confirm the diagnosis. Although surgery is the preferred treatment for cerebral sparganosis, praziquantel might also achieve satisfying outcomes.

Subcutaneous sparganosis mimicking soft tissue tumor: a case report

Background

Sparganosis is a rare parasitic disease of humans caused by invasion of human tissue by plerocercoid tapeworm larvae (spargana) of the genus Spirometra species. This parasite commonly invades subcutaneous tissue but can appear in any tissue of the body.

Case presentation

Here, we report a case of a 33-year-old woman presented with a migrating painful swelling and erythema in right thigh for 6 months, which was initially misdiagnosed as soft tissue tumor. Magnetic resonance imaging revealed a multiple elongated tubular tracts in the medial aspect of right thigh, from which a long, wrinkled, whitish worm was surgically removed. The parasite was histopathologically identified as Spirometra mansoni.

Conclusion

Sparganosis is rare and physicians have little experience, so if suspected, should be included among the list of differential diagnosis and special serological test should be recommended before surgery.

Human Sparganosis in Korea

BACKGROUND

Sparganosis is a larval cestodiasis caused by the plerocercoid of Spirometra spp. Since the first description of human sparganosis in 1924, several hundred cases have been reported in Korea. However, systematic approaches for literature surveys of Korean sparganosis have seldom appeared.

METHODS

We searched publicly available databases such as PubMed, Research Information Sharing Service, and Korea Medical Citation Index with relevant Medical Subject Headings.

RESULTS

At least 438 Korean sparganosis cases have been described from 1924 to 2015. Preoperative diagnosis has been significantly increased since the 1980s due to popularization of serological and imaging diagnostics. Cases were largely detected from fifth decades in general, but cerebral sparganosis was detected in relatively young age groups (third and fourth decades). Sparganosis was prevalent in men (75.9%). Consumption of frog/snake and drinking unfiltered water were found in 63.4% and 16.9% of patients, respectively. Most frequently affected sites were subcutaneous tissues (49.9%), followed by the central nervous system (36.2%). Involvements of visceral organs (7.6%), ocular regions (3.6%), and muscles (2.7%) were noticed. In women, breast sparganosis constituted a large proportion (34.2%). Sparganosis associated with immunocompromised patients has recently been reported.

CONCLUSION

Sparganosis has been continuously reported in Korea during the past 90 years, although its incidence has decreased during the last 20 years. The disease is mostly characterized by subcutaneous nodule, but infection of the worm in vital organs often results in serious illness. Continuous awareness is warranted to monitor sparganosis occurrence and associated clinical consequences.

A synoptic overview of golden jackal parasites reveals high diversity of species

The golden jackal (Canis aureus) is a species under significant and fast geographic expansion. Various parasites are known from golden jackals across their geographic range, and certain groups can be spread during their expansion, increasing the risk of cross-infection with other carnivores or even humans. The current list of the golden jackal parasites includes 194 species and was compiled on the basis of an extensive literature search published from historical times until April 2017, and is shown herein in synoptic tables followed by critical comments of the various findings. This large variety of parasites is related to the extensive geographic range, territorial mobility and a very unselective diet. The vast majority of these parasites are shared with domestic dogs or cats. The zoonotic potential is the most important aspect of species reported in the golden jackal, some of them, such as Echinococcus spp., hookworms, Toxocara spp., or Trichinella spp., having a great public health impact. Our review brings overwhelming evidence on the importance of Canis aureus as a wild reservoir of human and animal parasites.

Presumptive case of sparganosis manifesting as a hepatic mass: A case report and literature review

A 60-year-old man was admitted due to rectosigmoid colon cancer, and a hepatic mass was incidentally found during the staging work-up. The mass appeared cystic with a thick wall and contained multiple bizarre cord-like structures on ultrasound, computed tomography and magnetic resonance imaging. The differential diagnoses included organizing abscess/hematoma, foreign body granuloma and parasite infestation. Serologic study revealed anti-sparganum antibodies. Over 4-year follow-up, the patient did not complain of symptoms, and no changes in the characteristics of the liver mass were observed. Hepatic sparganosis is rare; only two cases have been clinically reported, and no detailed radiologic description was available until now. This case report presents a detailed radiologic description of a hepatic mass that could most likely represent hepatic sparganosis.

Seroprevalence of Sparganosis in Rural Communities of Northern Tanzania

In this study, the seroprevalence of sparganosis and its relationship with sociodemographic factors in northern Tanzania have been assessed. A total of 216 serum samples from two rural districts, Monduli and Babati, were tested for sparganosis using an enzyme-linked immunosorbent assay. The seroprevalence of anti-sparganum IgG antibodies was 62.5% (95% confidence interval [CI] = 56.1–68.9) in all age groups. There were significant associations between district (relative risk [RR] = 1.95, 95% CI = 1.42–2.69), education (RR = 1.40, 95% CI = 1.15–1.70), and pet ownership with seropositivity (RR = 1.48, 95% CI = 1.02–2.16) based on univariate analysis. However, only the district was significantly associated with seropositivity (odds ratio = 4.20, 95% CI = 1.89–9.32) in binary logistic regression analysis. Providing health education to people residing in sparganosis-endemic areas is likely to improve the efficacy of preventative measures and reduce human disease burden.

Ultrasonographic findings of the various diseases presenting as calf pain

There are various causes of calf pain. The differential diagnoses affecting the lower leg include cystic lesions, trauma-related lesions, infection or inflammation, vascular lesions, neoplasms, and miscellaneous entities. Ultrasound (US) provide detailed anatomical information of the calf structures, and it offers the ability to confirm, other calf abnormalities, particularly when deep vein thrombosis (DVT) is ruled out. The purpose of this article is to review the causes of a painful calf presenting as DVT and incidental findings found as part of the work-up of DVT, and to provide a broad overview of US findings and clinical features of these pathologies.

Breast sparganosis and incidentally detected subcutaneous and intramuscular sparganosis at several sites: case report and literature review

Sparganosis is an infestation caused by a tapeworm belonging to the genus Spirometra. We describe a surgically confirmed case of sparganosis in several organs including the breast, both lower extremities, anterior chest wall, inguinal area, and the psoas and gluteus muscles. Mammography, ultrasonography, and MRI imaging findings for our patient were characteristic of sparganosis. Ultrasonography revealed multiple elongated tubular hypoechoic structures with surrounding increased echogenicity. Mammographic findings included tortuous, lobular, and tubular densities. Short tau inversion recovery (STIR) MR images contained several elongated tubular tracts of high signal intensity. These imaging features were highly consistent with pathology results.

Axillary sparganosis which was misunderstood lymph node metastasis during neoadjuvant chemotheraphy in a breast cancer patient

Sparganosis of the breast is an uncommon disease, but should be considered in the differential diagnosis of unusual and suspicious breast masses. A history of ingesting contaminated water and direct ingestion of snakes and frogs may help in differential diagnosis of the mass. Complete surgical removal is the treatment of choice and provides a definite diagnosis. We report a case of multiple axillary lymph node sparganosis. It was first considered as an axillary metastasis of breast cancer because a newly axillary mass appeared in follow-up radiologic study after neoadjuvant chemotherapy. We performed curative breast cancer surgery and sparganosis was confirmed by extracting the worm during axillary dissection.

Sparganosis of the breast and lower extremities: sonographic appearance

Sparganosis is a rare parasitic infection caused by larvae of the genus Spirometra. It can involve any part of the human body and usually manifests as a mass in various locations. We report a case of recurrent sparganosis in the breast and lower extremities. Our patient had recurrent subcutaneous masses in her breast and lower leg that showed characteristic ultrasonographic imaging findings of serpentine, tubular structures with surrounding increased echogenicity. These imaging findings are well correlated with pathologic findings. Worms were identified in resected specimens confirming sparganosis.

Recurred sparganosis 1 year after surgical removal of a sparganum in a Korean woman

Sparganosis, an infection due to the plerocercoid of Spirometra erinacei, are found worldwide but the majority of cases occur in East Asia including Korea. This report is on a recurred case of sparganosis in the subcutaneous tissue of the right lower leg 1 year after a surgical removal of a worm from a similar region. At admission, ultrasonography (USG) of the lesion strongly suggested sparganosis, and a worm was successfully removed which turned out to be a sparganum with scolex. Since sparganum has a variable life span, and may develop into a life-threatening severe case, a patient once diagnosed as sparganosis should be properly followed-up for a certain period of time. Although imaging modalities were useful for the diagnosis of sparganosis as seen in this case, serological test such as ELISA should also be accompanied so as to support the preoperative diagnosis.

Breast Sparganosis Incidentally Detected by FDG PET/CT

Sparganosis is a rare, parasitic infection that is caused by the plercercoid tapeworm larvae of the genus Spirometra. Sparganosis is transmitted by ingestion of larvae-containing water or intermediate hosts, such as raw amphibians, and usually presented with a subcutaneous nodule in the abdominal wall, extremities, and genital organs. Among the various involved organs, the breast is a seldom encountered site for sparganosis. However, breast sparganosis has clinical importance, since it is generally presented with an indolent palpable mass that mimics malignancy, even without evidence of inflammation. Herein, we report a case of breast sparganosis that was detected incidentally by FDG PET/CT during staging work ups in a patient with gall bladder cancer.

Magnetic resonance imaging features of pathologically proven cerebral sparganosis

Objective

The purpose of this study was to identify characteristic magnetic resonance imaging (MRI) features of cerebral sparganosis, a rare parasitic disease caused by the plerocercoid larva of Spirometra mansoni.

Methods

This retrospective study reviewed medical records, computed tomography (CT) and MRI scans and pathological specimens from patients with pathologically proven cerebral sparganosis. The location, signal intensity and contrast enhancement characteristics of the lesions were assessed.

Results

Records of 12 patients (seven male and five female; age range 8–35 years) were reviewed. A total of 13 lesions were identified: of the 10 patients with supratentorial lesions, nine had a single lesion and one had bilateral hemispheric lesions. Two patients had a single lesion in the ependyma of the 4th ventricle. All lesions were iso-hypointense on T1-weighted images, slightly hypointense on T2-weighted images and surrounded by extensive oedema. Ten of the 13 lesions demonstrated a ‘string-knots sign’, characterized by a tangled string in a knot-like shape on contrast-enhanced MRI.

Conclusion

A string-knots sign enhancement pattern in cortical–subcortical regions should suggest the diagnosis of cerebral sparganosis.

Migration: a notable feature of cerebral sparganosis on follow-up MR imaging

BACKGROUND AND PURPOSE

Cerebral sparganosis is a rare parasitic infection caused by sparganum, which can migrate in the brain. The purpose of this study was to demonstrate the migration of cerebral sparganosis and describe its patterns on MR imaging.

MATERIALS AND METHODS

MR images of 14 patients with cerebral sparganosis treated from 2005 to 2011 were retrospectively reviewed. Diagnosis was made on the basis of a constellation of clinical history, laboratory tests, imaging findings, and histopathology. At least 3 MR imaging studies were performed for each patient during the follow-up period ranging from 12 to 38 months. Time interval, sites, enhanced pattern, and presumed routes of migration were evaluated.

RESULTS

Both the initial lesions and migrated ones exhibited the "tunnel" sign and multiloculated rim enhancement. Migration was detected between 4 and 18 months after the baseline MR imaging in 14 lesions (in 14 patients), while 3 of 14 lesions showed a second migration between 22 and 38 months. Nearly all migrations were limited to the same hemisphere except for 2 contralateral migrations through the thalamus. Most of the migrations were in close proximity (within the same lobe, to the adjacent lobe, from the basal ganglia to the cortex, from the cerebellum to the pons and interthalamus) except 1 from the basal ganglia to the cerebellum. A signal change along the presumed route of migration was seen in 3 patients.

CONCLUSIONS

Migration is a notable feature of cerebral sparganosis. Demonstration of migration on MR imaging could be a key diagnostic clue and beneficial for the treatment policy.

Cervical sparganosis: case reports with focus on radiological findings

BACKGROUND

Cervical sparganosis is a rare condition that presents as a lateral neck mass. Its radiological findings have not previously been investigated. Thus, the important radiological findings of cervical sparganosis are presented herein.

METHODS

We report two patients with cervical sparganosis who presented with cervical masses, and we review the relevant head and neck literature. Computed tomography was performed three times over 13 months of follow up for one patient.

RESULTS

On follow-up radiological examination, a migratory lesion with a tubular appearance, seen on serial images, should be considered significant for cervical sparganosis.

CONCLUSION

Radiologically, a migratory cervical mass in the head and neck area with a tubular appearance is suggestive of cervical sparganosis.

Parasitic infections and myositis

Infectious myositis may be caused by a wide variety of bacterial, fungal, viral, and parasitic agents. Parasitic myositis is most commonly a result of trichinosis, cystericercosis, or toxoplasmosis, but other parasites may be involved. A parasitic cause of myositis is suggested by history of residence or travel to endemic area and presence of eosinophilia. The diagnosis of parasitic myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by parasitologic, serologic, and molecular methods, together with histopathologic examination of tissue biopsies. Therapy is based on the clinical presentation and the underlying pathogen. Drug resistance should be put into consideration in different geographic areas, and it can be avoided through the proper use of anti-parasitic drugs.

Two-dimensional immunoblot analysis of antigenic proteins of Spirometra plerocercoid recognized by human patient sera

Sparganosis is caused by invasion of Spirometra plerocercoid into various tissues/organs. Subcutaneous sparganosis can be diagnosed and treated by worm removal, while visceral/cerebral sparganosis is not easy to diagnose. The diagnosis depends largely on the detection of specific antibodies circulating in the patients' sera. Previous studies demonstrated that 31 and 36kDa proteins of the sparganum invoked specific and sensitive antibody responses, but also showed cross reactions with cysticercosis sera. We enriched protein fractions containing 31-36kDa through gel filtration and examined immune recognition pattern against the patient sera by 2-dimensional electrophoresis (2-DE) followed by immunoblotting. Serum samples from sparganosis patients recognized 8-10 protein spots of 31 and 36kDa with different isoelectric point (pI) values with variable combinations, in which four spots of 31kDa with pIs 3.4, 3.9, 4.0 and 4.1, and one 36kDa spot (pI 3.5) appeared to be specifically reactive. One 31kDa protein spot with pI 3.3 and two spots of 36kDa with pIs 3.3 and 3.5 reacted crossly with neurocysticercosis sera. Neither sera from patients with other parasitic infections nor those from healthy controls showed positive reaction. Two-DE/immunoblot analysis might be highly available in differential serodiagnosis of human sparganosis.

A case of sparganosis in the leg

The life-span of the sparganum in humans is not exactly known, but it may survive longer than 5 years in some patients. We experienced a case infected with a sparganum that is presumed to have lived for 20 years in a patient's leg. The patient was a 60-year-old woman, and she was admitted to a hospital due to ankle pain that was aggravated on dorsiflexion. She had noticed a mass on her knee some 20 years ago, but she received no medical management for it. The mass moved into the ankle joint 3 months before the current admission, and then the aforementioned symptoms appeared. A living sparganum was recovered by surgery, and the calcified tract near the knee was proved to be the pathway along which the larva had passed.

Breast and scrotal sparganosis: sonographic findings and pathologic correlation

OBJECTIVE

Sparganosis is caused by the tapeworm larva of the geneus Spirometra. Because sparganosis usually manifests as a migrating subcutaneous mass, sonography can play an important role in its diagnosis.

METHODS

In this series, we investigated 4 cases of subcutaneous sparganosis and focused on the sonographic findings. Three of the cases involved the breast, and the other involved the scrotum, as confirmed by surgery.

RESULTS

The characteristics of subcutaneous sparganosis included a poorly defined hyperechoic lesion with internal serpiginous tubular structures, anechoic serpiginous tubular structures with a surrounding hyperechoic lesion, and an elongated hyperechoic mass with a hypoechoic nodular lesion in the central portion.

CONCLUSIONS

We suggest that a mass combined with a hypoechoic tubular structure should raise the suspicion of subcutaneous sparganosis.

Biological risks associated with consumption of reptile products

The consumption of a wide variety of species of reptiles caught from the wild has been an important source of protein for humans world-wide for millennia. Terrapins, snakes, lizards, crocodiles and iguanas are now farmed and the consumption and trade of their meat and other edible products have recently increased in some areas of the world. Biological risks associated with the consumption of products from both farmed and wild reptile meat and eggs include infections caused by bacteria (Salmonella spp., Vibrio spp.), parasites (Spirometra, Trichinella, Gnathostoma, pentastomids), as well as intoxications by biotoxins. For crocodiles, Salmonella spp. constitute a significant public health risk due to the high intestinal carrier rate which is reflected in an equally high contamination rate in their fresh and frozen meat. There is a lack of information about the presence of Salmonella spp. in meat from other edible reptilians, though captive reptiles used as pets (lizards or turtles) are frequently carriers of these bacteria in Europe. Parasitic protozoa in reptiles represent a negligible risk for public health compared to parasitic metazoans, of which trichinellosis, pentastomiasis, gnathostomiasis and sparganosis can be acquired through consumption of contaminated crocodile, monitor lizard, turtle and snake meat, respectively. Other reptiles, although found to harbour the above parasites, have not been implicated with their transmission to humans. Freezing treatment inactivates Spirometra and Trichinella in crocodile meat, while the effectiveness of freezing of other reptilian meat is unknown. Biotoxins that accumulate in the flesh of sea turtles may cause chelonitoxism, a type of food poisoning with a high mortality rate in humans. Infections by fungi, including yeasts, and viruses widely occur in reptiles but have not been linked to a human health risk through the contamination of their meat. Currently there are no indications that natural transmissible spongiform encephalopathies (TSEs) occur in reptilians. The feeding of farmed reptiles with non-processed and recycled animal products is likely to increase the occurrence of biological hazards in reptile meat. Application of GHP, GMP and HACCP procedures, respectively at farm and slaughterhouse level, is crucial for controlling the hazards.

Intramuscular and subcutaneous sparganosis: Sonographic findings

A case of subcutaneous and intramuscular sparganosis was confirmed on surgical excision of a worm in a 60-year-old woman suffering from painful masses in the right thigh. Sonography and MRI revealed an ill-defined intramuscular lesion and multiple cystic lesions in the subcutaneous tissue. At the time of the excision, a sparganum larva was found in the adductor longus muscle. If an intramuscular mass with a serpiginous cystic tract is seen on imaging studies in an endemic area, musculoskeletal sparganosis should be included in the differential diagnosis of a soft tissue tumor.

Scrotal sparganosis: with an emphasis on ultrasonographic findings

Scrotal sparganosis is a rare parasitic infestation in which humans serve as the second intermediate host for a tapeworm of the genus Spirometra. We present one case of a 44-year-old man with an emphasis on the ultrasound (US) findings. The patient had a palpable scrotal subcutaneous nodule and a history of eating raw snakes 7 years prior. On US, we noted a well-defined, long, tubular, serpiginous lesion that had three different echoic layers, i.e., a peripheral low echoic rim, an intermediate high echoic line, and an inner slightly low echoic content that had a tram-tract appearance.

CT and MR characteristics of cerebral sparganosis

BACKGROUND AND PURPOSE

Sparganosis is a rare parasitic infection in humans by a larval cestode of the genus Spirometra. Preoperative diagnosis of cerebral sparganosis in the past has been very difficult. Our objective was to evaluate the CT and MR features of cerebral sparganosis in order to make a definite diagnosis.

MATERIALS AND METHODS

We retrospectively reviewed 25 patients (13 male and 12 female; age range, 9-83 years) who proved to have cerebral sparganosis. Fifteen patients underwent MR imaging: 2 patients had CT scanning, and the remaining 8 had both CT and MR scanning. We focused on evaluating the imaging features on CT and MR.

RESULTS

All patients showed edema and degeneration of cerebral white matter. All but 1 had a unilateral lesion. Twenty-two patients had ipsilateral ventricular dilation. The new finding was a tunnel sign, approximately 4 cm in length and 0.8 cm in width, column or fusiform shaped on postcontrast coronal and sagittal MR images (n = 10). Thirteen patients showed bead-like enhancement, but solitary ring enhancement was common on the CT images (n = 2). The wall of the ring and tunnel appeared isointense or slightly hyperintense on T2-weighted images. Punctate calcifications were seen in 6 patients on CT images but only in 3 patients on the MR images. Hemorrhage was seen in 4 patients on the MR images. An intact whitish, stringlike, living worm was found (n = 5).

CONCLUSION

The most characteristic finding was a tunnel sign on postcontrast MR images. The most common finding was bead-shaped enhancement. MR is superior to CT in demonstrating the extent and number of lesions, except punctate calcifications. Combined with clinical data and enzyme-linked immunosorbent assay, the preoperative diagnosis of cerebral sparganosis could be established on MR imaging.

Case of subcutaneous sparganosis: Use of imaging in definitive preoperative diagnosis

Herein, we report a rare case of subcutaneous sparganosis in a 60-year-old Japanese woman. She had a 2 cm x 2 cm elastic-hard, subcutaneous nodule, which was the larva of a tapeworm, and a surrounding granuloma in her internal thigh. It was thought that she became infected by drinking water contaminated with the worm. She was definitively diagnosed by enzyme-linked immunosorbent assay (ELISA). After excision of the lesion, the titer of ELISA showed clear decline; therefore, we could conclude that she had been completely freed from sparganosis. The magnetic resonance imaging (MRI) and ultrasound sonography of her subcutaneous nodule demonstrated the characteristic signs: a band-like structure in the MRI and a coiled linear hypoechoic body in a clear, oval mass in the ultrasound sonography.

A surgically confirmed case of breast sparganosis showing characteristic mammography and ultrasonography findings

A case of breast sparganosis was confirmed by surgical excision of a worm (fragmented into 5 pieces) in a 59-year-old Korean woman suffering from a palpable mass in the left breast. Mammography and ultrasonography characteristically revealed the presence of several well-defined, isodense and hypoechoic tubular masses, in the upper quadrant of the left breast, each mass consisting of a continuous cord- or worm-like structure. During surgery, a long segment of an actively moving sparganum of Spirometra sp. and 4 small fragments of the same worm, giving a total length of 20.3 cm, were extracted from the upper outer quadrant of the left breast and the axillary region. The infection source remains unclear, because the patient denied ingesting any snake or frog meat or drinking untreated water.

A case of sparganosis mimicking a varicose vein

Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.

Spectrum of sonographic findings in superficial breast masses

OBJECTIVE

The purpose of this presentation is to show the sonographic findings of breast masses, which can occur in subcutaneous fat or in the cutaneous layer of the breast.

METHODS

We reviewed the sonographic findings of superficial breast masses, including the epidermal inclusion cyst, steatocystoma multiplex, fat necrosis, accessory breast, Mondor disease, sparganosis, neurofibroma, tuberculosis, mastitis, and breast malignancy.

RESULTS

Specific sonographic features of superficial breast masses have been illustrated.

CONCLUSIONS

Radiologists must be familiar with the sonographic findings of various diseases involving the superficial layer of the breast to avoid further patient workup.

Eyelid sparganosis

PURPOSE

To report a case of sparganosis in the muscle layer of the eyelid.

DESIGN

Observational case report.

METHODS

A 67-year-old man with migratory painful swelling on the eyelid that was unresponsive to medications was evaluated and treated surgically.

RESULTS

Computed tomography showed a 1.5 x 1.5-cm sized, thick-walled lesion and ultrasound biomicroscopy showed hypoechoic tubular and cystic lesions. During surgery, a white, thread-like plerocercoid, 7 cm in length was detected in the orbicularis muscle of the lower eyelid. Histopathologic examination demonstrated the characteristic feature of the sparganum larva and foreign body granulomatous reaction. Serodiagnosis by enzyme-linked immunosorbent assay was positive. Three months postoperatively, the lesion resolved completely.

CONCLUSION

Although rare, sparganosis should be suspected in a moving eyelid mass unresponsive to the medical treatment.

Human sparganosis in Italy. Case report and review of the European cases

Infections with Spargana, the larvae of Spirometra spp., are rarely found in humans in Europe. So far only six cases have been discussed in the literature, four from Italy and two from France. We here report a new case in a 50-year-old workman, a freshwater sports fisherman from Bologna in Northern Italy. The infection manifested as a subcutaneous nodule in the thigh, 2x3 cm in size, slightly painful when compressed, somewhat mobile under the skin, present for 9 months, with recurrent periods of local itchiness associated with redness and slight oedema. The lump was removed surgically. Histological sections of the biopsied material revealed the presence of a sparganum. Drinking water contaminated by copepods, containing procercoid larvae of this parasite, seems to be the medium of infection.

Sparganosis: a rare case of the oral cavity

Sparganosis is a rare parasitic disease. We here reported an extremely rare case of intraoral sparganosis in a 21-year-old Thai female. Clinically, the lesion presented as an asymptomatic nodule 1 cm x 1 cm in the left upper labial mucosa. An excisional biopsy was performed and the pathological examinations revealed a larva of a sparganum surrounded by a fibrous capsule heavily infiltrated with eosinophils. Excision of the lesion was curative. The possible route of infection of the patient might be due to drinking water, contaminated with Cyclops containing procercoid larvae.