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Ultrasound diagnosis of Ascaris lumbricoides in the pancreatic duct: the “four-lines” sign

1988; Wiley; Volume: 61; Issue: 725 Linguagem: Inglês

10.1259/0007-1285-61-725-411

1748-880X

Jeremy Price, Joseph W. Leung,

Pancreatitis Pathology and Treatment

Ascariasis is a common human intestinal infestation, occurring throughout the world. Biliary colic, cholangitis and pancreatitis may follow migration of worms into the biliary tract. We report a case of acute pancreatitis in which an ascaris worm in the pancreatic duct was diagnosed on the characteristic ultrasonographic appearances. A 64-year-old Chinese lady presented several hours after a sudden onset of severe epigastric and right upper quadrant pain. There was no history of any previous similar episodes. On examination she had a pyrexia of 37.6°C and mild upper abdominal tenderness. Laboratory investigations showed a serum amylase elevated to 1640 U/l (normal range 44–128 U/l). Serum alkaline phosphatase and total bilirubin were marginally raised. A diagnosis of acute pancreatitis was made, which showed clinical and biochemical improvement with conservative management over the next 5 days. Ultrasound examination was then performed on an Aloka 280 real-time unit using a 5 MHz linear-array probe.