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Taenia Saginata small bowel infestation

Posted Wed, 01/06/2010 - 18:40 by Norman Loberant
Images

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Figure 1d

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Figure 2d


Clinical History:

Case 1. 44-year-old male admitted for chest and epigastric pain, referred for out-patient CT.
Case 2. 26-year-old female with a history of seronegative arthritis, admitted for workup of diffuse abdominal pain and allergic urticaria, referred for in-patient abdominal CT.


Findings:

Patient 1. (Fig 1a,b,c.) Axial CT images of the abdomen and pelvis with oral contrast shows extensive thin, linear, low attenuation filling defects within the small bowel lumen from the level of the mid-abdomen to the pelvis.
Fig 1d. Magnified view of small bowel showing linear filling defects within small bowel loops.
Patient 2. (Fig. 2a,b,c ) AxialCT of the pelvis with oral contrast shows thin, linear, low attenuation filling defects within the small bowel lumen. These are far less extensive than in the first patient.
Fig. 2d. Detail of small bowel showing linear filling defects within small bowel loops.


Diagnosis:

Taenia Saginata infestation of the small bowel, confirmed in both patients by parasitological examination of the stool.


Discussion:

Taenia Saginata, the beef tapeworm, is acquired by ingestion of raw or undercooked meat and is most prevalent in sub-Saharan African and Middle Eastern countries. The larval cyst, or cysticercus, develops in the muscles of infected beef, the intermediate host. When a viable cysticercus is ingested by man, it releases the scolex which attaches to the small intestinal wall, and begins to bud off a long chain of segments (proglottides). Man is the only definitive host and is usually infested by a single worm. The tapeworm reaches a length of 5-10 meters, and its lifespan is up to 25 years (1).
The disease is often clinically silent, although patients may complain of nonspecific symptoms including occasional nausea or vomiting, appetite loss, epigastric or umbilical pain, and weight loss. Moderate eosinophilia may develop.( In our Case 1 there were 2% eosinophils, in Case 2 four CBC’s showed eosinophils between 0-7%.)
Confirmation of diagnosis is possible only by stool examination, but radiologic studies can be helpful in suggesting the diagnosis, especially given the nonspecific clinical picture.
Descriptions of characteristic radiologic findings for Taenia Saginata infestation on barium studies (1), as well as a recent description of confirmed small bowel infestation made by MR enterography have revealed a similar pattern of oral contrast surrounding thin, continuous, filling defects representing the long thin worm residing within the small bowel loops (2).


References / Suggested Reading:

1.Gold BM, Meyers MA. Radiological manifestations of Taenia saginata infestation. AJR 1977;128:493-494
2. Paolantonio P, Rengo M, Iafrate F, Martino G, Laghi A. Diagnosis of Taenia saginata by MR Enterography. AJR 2006;187:W238


Author

Abramovici E, Herskovits M, Loberant N

Department of Radiology

Western Galilee Hospital, Nahariya, Israel

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