Presentation
Abdominal discomfort.
Patient Data
Numerous small, curvilinear calcifications throughout the liver and peritoneal cavity involving the mesentery, omentum, and large and small bowel. Additionally, there are a few calcifications within the lower lungs. No other acute findings. Incidental note of prostate brachytherapy seeds.
Case Discussion
The characteristic appearance of an uncommon diagnosis called pentastomiasis is caused by consuming contaminated snake meat or bushmeat, specifically caused by the parasite Armillifer armillatus 1. This has been more commonly seen in West Africa, particularly Nigeria.
Armillifer lives in the trachea and bronchi of infected snakes. After ingesting contaminated bushmeat, Armillifer eggs hatch in the intestine, and the larvae cross the intestinal wall and migrate into various tissues. As these larvae die, they cause an inflammatory response, forming the characteristic curvilinear or horseshoe/comma-shaped calcifications. Many cases are asymptomatic, however, the inflammatory response can progress to hepatic fibrosis.
This patient was from West Africa and confirmed consumption of snake meat from a local bushmeat market. This confirmatory history along with the imaging findings are considered pathognomonic.
Case courtesy of Dr. Barry Rush, MD.
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