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Insights into Imaging

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Open Access 01-12-2023 | Computed Tomography | Original Article

Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound

Authors: Roberto Fornell-Perez, Maite Urizar-Gorosarri, Uxue Martinez-Urabayen, Marta Perez-Bea

Published in: Insights into Imaging | Issue 1/2023

Abstract

Background

To assess the frequency of appearance of various signs (isolated and grouped) in emergency imaging tests in patients with anisakiasis, according to the location of gastrointestinal tract involvement.

Methods

Retrospective review by two experienced radiologists of emergency ultrasounds and CTs performed on patients admitted in the Emergency Department of our hospital with later confirmed anisakiasis (2010–2021), assessing the presence of signs suggesting anisakiasis. Calculation of the frequency of appearance according to the gastric or intestinal location, as well as the most common grouped signs.

Results

Out of 231 total patients with anisakiasis, imaging studies were performed in 144: abdominopelvic ultrasound in 43 cases and CT in 111 (both techniques in 31). In cases with gastric occurrence (34), in CT the wall stratification (100%), wall thickening (97%), fat stranding (91%) and ascitic fluid (82%) were predominant. In the intestinal cases (105), in CT (95) the wall thickening (100%), fat stranding (92%) and mesenteric vessel engorgement (83%) were usual; in ultrasound (40), ascitic fluid and wall thickening (70% in both cases) were frequently observed. The frequency of grouped appearance of the mentioned signs was 82% in gastric cases, 80% in intestinal cases and 50% in ultrasounds. Multisegment involvement in CT reached 28% (gastric + intestinal) and 11% (only intestinal) of cases.

Conclusions

The most frequent CT findings in patients with gastric anisakiasis are wall stratification and thickening, fat stranding and ascitic fluid. In the intestinal cases, wall thickening, fat oedema and vessel engorgement are the most often observed findings.

Critical relevance statement

The presence of different radiological signs makes it advisable to include anisakiasis in the differential diagnosis of acute abdomen. Intestinal and multifocal involvement rates are greater than previously reported.

Key points

• In gastric anisakiasis, CT frequently shows wall stratification and thickening, fat stranding and ascitic fluid.

• In intestinal anisakiasis, CT often presents wall thickening, fat stranding and vessel engorgement.

• In intestinal anisakiasis, ultrasounds most frequently show ascitic fluid and wall thickening.

Graphical Abstract

Shimamura Y, Muwanwella N, Chandran S et al (2016) Common symptoms from an uncommon infection: gastrointestinal Anisakiasis. Can J Gastroenterol Hepatol 2016:5176502. https://doi.org/10.1155/2016/5176502CrossRefPubMedPubMedCentral

Hochberg NS, Hamer DH (2010) Anisakidosis: perils of the Deep. Clin Infect Dis 51:806–12. https://doi.org/10.1086/656238CrossRefPubMed

Audicana MT, Ansotegui IJ, Fernandez de Corres L, Kennedy MW (2002) Anisakis simplex: dangerous — dead and alive ? Trends Parasitol 18:20–25. https://doi.org/10.1016/s1471-4922(01)02152-3CrossRefPubMed

Shibata E, Ueda T, Akaike G, Saida Y (2014) CT findings of gastric and intestinal anisakiasis. Abdom Imaging 39:257–261. https://doi.org/10.1007/s00261-014-0075-3CrossRefPubMedPubMedCentral

Ripolles T, Lopez-Calderon LE, Martínez-Perez MJ et al (2020) Usefulness of Ultrasound in the Diagnosis of Intestinal Anisakiasis. J Ultrasound Med 39:1703–8. https://doi.org/10.1002/jum.15268CrossRefPubMed

Lalchandani UR, Weadock WJ, Brady GF, Wasnik AP (2018) Imaging in gastric anisakiasis. Clin Imaging 50:286–288. https://doi.org/10.1016/j.clinimag.2018.04.018CrossRefPubMed

Repiso Ortega A, Alcántara Torres M, González de Frutos C et al (2003) Anisakiasis gastrointestinal. Estudio de una serie de 25 pacientes. Gastroenterol Hepatol 26:341–346. https://doi.org/10.1016/s0210-5705(03)70370-7CrossRefPubMed

Fornell Pérez R, Urizar Gorosarri M, Pérez Bea M (2022) Anisakiasis: manifestaciones radiológicas. Radiologia 64:245–255. https://doi.org/10.1016/j.rx.2022.04.001CrossRefPubMed

Ishikura H, Kikuchi K, Nagasawa K et al (1993) Anisakidae and anisakidosis. Prog Clin Parasitol 3:43–102. https://doi.org/10.1007/978-1-4612-2732-8_3CrossRefPubMed

10.

Yagihashi A, Sato N, Takahashi S, Ishikura H, Kikuchi K (1990) A serodiagnostic assay by microenzyme-linked immunosorbent assay for human anisakiasis using a monoclonal antibody specific for Anisakis larvae antigen. J Infect Dis 161:995–998CrossRefPubMed

11.

Kim T, Song HJ, Uk Jeong S et al (2013) Comparison of the clinical characteristics of patients with small bowel and gastric Anisakiasis in Jeju Island. Gut Liver 7:23–29. https://doi.org/10.5009/gnl.2013.7.1.23CrossRefPubMed

12.

Takabayashi T, Mochizuki T, Otani N et al (2014) Anisakiasis presenting to the ED: Clinical manifestations, time course, hematologic tests, computed tomographic findings, and treatment. Am J Emerg Med 32:1485–1489. https://doi.org/10.1016/j.ajem.2014.09.010CrossRefPubMed

13.

Lee JS, Kim BS, Kim SH et al (2014) Acute invasive small-bowel Anisakiasis: Clinical and CT findings in 19 patients. Abdom Imaging 39:452–458. https://doi.org/10.1007/s00261-014-0106-0CrossRefPubMed

14.

Klein J, Vinson EN, Helms CA, Brant WE (2018) Brant and Helms’ Fundamentals of Diagnostic Radiology, 5th edn. Wolters Kluwer, Philadelphia

15.

Fernandes T, Oliveira MI, Castro R, Araújo B, Viamonte B, Cunha R (2014) Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging 5(2):195–208. https://doi.org/10.1007/s13244-013-0308-yCrossRefPubMedPubMedCentral

16.

Kimura K, Stoopen M (2008) Stomach and duodenum. In: Pedrosa C (ed) Diagnostic imaging – Abdomen, 3rd edn. Marban, Madrid, p 421

17.

Lucey BC, Stuhlfaut JW, Soto JA (2005) Mesenteric lymph nodes: detection and significance on MDCT. AJR Am J Roentgenol. 184(1):41–4. https://doi.org/10.2214/ajr.184.1.01840041CrossRefPubMed

18.

Dorfman RE, Alpern MB, Gross BH, Sandler MA (1991) Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology. 180(2):319–22. https://doi.org/10.1148/radiology.180.2.2068292CrossRefPubMed

19.

Ido K, Yuasa H, Ide M et al (1998) Sonographic diagnosis of small intestinal anisakiasis. J Clin Ultrasound 26:125–30. https://doi.org/10.1002/(sici)1097-0096(199803/04)26:3%3c125::aid-jcu3%3e3.0.co;2-oCrossRefPubMed

20.

Lorenzo S, Iglesias R, Leiro J et al (2000) Usefulness of currently available methods for the diagnosis of Anisakis simplex allergy. Allergy 55:627–633. https://doi.org/10.1034/j.1398-9995.2000.00471.xCrossRefPubMed

21.

González Quijada S, González Escudero R, Arias García L et al (2005) Manifestaciones digestivas de la anisakiasis: Descripción de 42 casos. Rev Clin Esp 205:311–315. https://doi.org/10.1157/13077114CrossRefPubMed

22.

Sasaki T, Fukumori D, Matsumoto H et al (2003) Small Bowel Obstruction Caused by Anisakiasis of the Small Intestine: Report of a Case. Surg Today 33:123–125. https://doi.org/10.1007/s005950300027CrossRefPubMed

23.

Mizumura N, Okumura S, Tsuchihashi H et al (2018) A Second Attack of Anisakis: Intestinal Anisakiasis Following Gastric Anisakiasis. ACG Case Reports J 5:e65. https://doi.org/10.14309/crj.2018.65CrossRef

24.

Fujikawa H, Kuwai T, Yamaguchi T et al (2018) Gastric and enteric anisakiasis successfully treated with Gastrografin therapy: a case report. World J Gastrointest Endosc 10:69–73. https://doi.org/10.4253/wjge.v10.i3.69CrossRefPubMedPubMedCentral

25.

Kim SH, Park CW, Kim SK et al (2013) A Case of Anisakiasis invading the stomach and the colon at the same time after eating anchovies. Clin Endosc 46:293. https://doi.org/10.5946/ce.2013.46.3.293CrossRefPubMedPubMedCentral

26.

Ogata M, Tamura S, Matsunoya M (2015) Sonographic diagnosis of intestinal anisakiasis presenting as small bowel obstruction. J Clin Ultrasound 43:283–287. https://doi.org/10.1002/jcu.22194CrossRefPubMed

Title: Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound
Authors: Roberto Fornell-Perez
Maite Urizar-Gorosarri
Uxue Martinez-Urabayen
Marta Perez-Bea
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Computed Tomography
Computed Tomography
Ultrasound
Ultrasound
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01511-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound

Abstract

Background

Methods

Results

Conclusions

Critical relevance statement

Key points

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Critical relevance statement

Key points

Graphical Abstract

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