소아에서 진단된 다발성 저음영 결절 형태를 보인 간흡충증 1례

A Case of Clonorchis Sinensis with Multiple Low Echogenic Nodules in a Child

한국은 간흡충증의 집중유행지역이고 성인에서의 간흡충증과 합병증의 보고는 많이 있었으나 소아의 경우 보고가 없었다. 본 증례는 8세 소아의 대변검사에서 충란을 발견하여 간흡충증을 진단하였다. 방사선 검사 소견에서는 이전에 보고된 전형적인 간흡충증의 방사선 소견과는 달리 간내 말초담도계의 확장 없이 간실질에 다발성의 저음영 결절과 간문맥내에 임파선 증식을 보였다. 저자들은 환아의 과거력 및 임상증상과 말초혈액 검사소견 등을 미루어 볼 때, 이러한 소견을 간흡충 감염에서 급성기의 방사선학적 소견이 아닌가 추정하였다. 이에 8세 남아의 대변검사에서 충란을 발견하여 확진하고 praziquantel 경구복용으로 치유한 1례를 보고하는 바이다.

Clonorchiasis, known as the parasitic fluke in the intrahepatic bile ducts, occurs throughout Korea, Japan, Taiwan, and Vietnam with high frequency. Most of the infections follow the consumptions of raw or undercooked freshwater fish, which explains its rare occurrence to childhood even in those areas mentioned earlier above. The authors have experienced it with an 8 year old boy. Abdominal ultrasonogram revealed multiple low echogenic nodules in the right lobe of liver and lymph nodes proliferation around the porta hepatis area. And abdominal C.T. scan also found multiple low attenuated nodules with delayed enhancement in liver parenchyma with hepatomegaly and multiple conglomerated lymph nodes in porta hepatis. Both abdominal ultrasonogram and C.T. scan didn't show any dilatation of peripheral intrahepatic bile ducts. In repeated stool examination, Clonorchis sinensis eggs were found in feces and the result of the skin test for Clonorchis sinensis was positive. The patient had a history of having eaten raw pond smelt back in Cheongju a month before the symptom onset. On the basis of the patient's history and the fact that Clonorchis eggs were found in feces 3 weeks after eosinophilia and symptoms were noted, the authors estimated that the findings of the patient's abdominal sonogram and C.T. scan were the radiologic findings of the acute phase of clonorchiasis, of which no report had ever been made before. So the authors report a case of clonorchiasis with atypical radiologic findings in an 8 year old boy.