A 13 year old female with jaundice and history of pica. MRCP images are provided. What is your diagnosis?

Images A and B

Figure 1

Figure 2

Answer

CBD Ascariasis

Further Information—

Ascariasis is a common disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas . Numerous studies have been published on biliary tract ascariasis. All these have documented ultrasonography as the primary imaging modality for biliary tract ascariasis . Magnetic Resonance Cholangiopancreatography (MRCP) has been the latest entrant for the study of bilary tract. On ultrasound appearance is that of tubular echogenic nonshadowing structures with a thin longitudinal central sonulecent line, multiple worms in CBD produce ‘spaghetti sign' or manifest as hyperechoic pseudotumors. MRCP shows intraductal worms as linear hypointense filling defects in the biliary tree.

To conclude, serpentine hypointense structures in gall bladder and CBD on MRCP should bring diagnosis of biliary ascariasis into consideration