Unusual cause of biliary obstruction : hepatobiliary fascioliasis

We report a 30-year old female who presented to our clinic with severe abdominal pain, irradiating to the back, weight loss, fatigue and anorexia. The laboratory findings revealed increased levels of alanine trans- aminase, aspartate transaminase and bilirubin. The patient underwent abdominal ultrasonography (US) and magnetic resonance imaging (MRI). US showed hypoechoic areas located mainly in the subcapsular region of the liver. On MRI, hypointense lesions on T1- weighted images and hyperintense nodular lesions on T2-weighted images were seen within the liver (Fig. 1). Nodular lesions were peripherally enhancing in gadolin- ium-enhanced images. According to the US and MRI results hepatobiliary fascioliasis was considered as a diagnosis. Subsequently, endoscopic retrograde cholan- giopancreatography (ERCP) was performed and fasciola flukes were extracted from extrahepatic bile ducts.