Differential diagnosis of gallbladder ascariasis debris: the added value of contrast enhanced ultrasound with high frequency transducer

Abstract

Ascariasis debris of the gallbladder is a very rare incidental or symptomatic presentation. Ascaris debris has a pseudotumorous appearance and may be confused with neoplasia. The aim of the current retrospective study is to investigate the value of contrast enhanced ultrasound (CEUS) for the differential diagnosis of ascariasis debris and neoplasia of the gallbladder.

Material and methods: Conventional B-mode ultrasound (BMUS) and CEUS were performed for solitary echo-rich gallbladder lesions. Analysis of the CEUS enhancement pattern of the lesions was conducted according to the current EFSUMB guidelines. Two radiologists assessed the CEUS enhancement patterns in consensus. The final gold standard was surgery with histological examination or imaging follow-up.

Results: A total of 9 patients with final diagnoses of gallbladder ascariasis debris were included. As a control group 26 solitary hyperechoic gallbladder lesions without shadowing were included as a control group. The typical zigzag morphology with multiple echogenic parallel lines without shadow were detected inside the lumen of the gallbladder in 6 patients. After injection of 2.4 ml ultrasound contrast agents, all hyperechoic gallbladder ascariasis debris lesions showed no enhancement. All patients in the control group with similar BMUS morphology showed contrast enhancement.

Conclusions: Real time visualization of contrast enhancement without radiation exposure is one of the main advantages of CEUS over other diagnostic modalities to differentiate ascariasis debris in the gallbladder from enhancing neoplasia. Thus, surgery and other interventions and their complications could be avoided.