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Granulomas and Bowel Wall Thickening

Apart from the more common tropical infections already described (amebiasis, tuberculosis, schistosomiasis, hydatid disease, ascariasis, etc.) there are other causes of hepatic granulomas and bowel wall thickening which must be remembered where geographically appropriate (refer to the appropriate chapters on each disease). All can be demonstrated by ultrasonography.

Toxocariasis. Multiple granulomas as well as a single large lesion in the liver have been reported in man.

Strongyloidiasis. If the host is immunosuppressed, S. stercoralis infections may show as abscesses or edema in the liver or kidney. Ultrasonography can also demonstrate thickening of the bowel wall and inflammatory changes in the mesenteric lymph nodes.

Helminthoma. Ultrasonography may show a small tumor in the bowel wall caused by the penetration of the gut by the nematodes Oesophagostomum and Ancylostoma. The infection may extend into the mesocolon to form a large granuloma (see chapter on Helminthoma).

Intestinal Capillariasis. Ultrasonography will show thickening of the bowel wall with moderate ascites and enlarged mesenteric lymph nodes: hepatic microabscesses may be so numerous as to cause gross hepatomegaly (see chapter on Capillariasis).

Ancylostomiasis. Minor edematous changes are found in the jejunum and rarely there may be a helminthoma (see chapter on Ancylostomiasis).

Anisakiasis. Can cause thickening of the bowel wall, especially the ileum, which may simulate acute appendicitis, Crohn's disease, tuberculosis, or carcinoma of the colon. Thickening of the gastric mucosa has been recorded on endoscopic ultrasonography (see chapter on Anisakiasis).

Gnathostomiasis (larva migrans). Hepatic granulomas have been recognized with ultrasonography (see chapter on Gnathostomiasis).

Clonorchiasis and Opisthorchiasis (see chapter on Clonorchiasis).

Fascioliasis. Usually causes a mild disease in man, but severe infections may cause dilated bile ducts, periductal fibrosis, microabscesses, jaundice, and pleural effusion. Nonshadowing, nonspecific vermiform images have been detected in the gallbladder on ultrasound scans (see chapter on Clonorchiasis).

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