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The possibility of Clonorchiasis should be kept in mind when evaluating patients with a history of exposure to raw fish in endemic areas and who show signs of liver disease.

Stool examination (most reliable): Detection of eggs in feces: formalin-ether is the preferred method of stool examination. (Images)

Enteric capsule or string test (Enterotest): Detection of eggs in small intestinal mucosa.

T-tube/endoscopic/transhepatic cholangiogram: adult flukes in the large and medium-sized intrahepatic ducts
Ultrasound: Biliary stasis, sludge and stones associated with dilatation and constriction of the bile ducts. Useful in the detection of bile duct dilatation and fibrous thickening of the duct walls. Can miss stones and sludge as they are isoechoic relative to the liver.
CT: demonstrates intra- and extrahepatic ductal dilatation, abcesses, atrophy, and hyperattunuated stones or sludge.
MRI: parallel CT, although may be useful in detecting subtle cases of cholangiocellular carcinoma.

This page is based on information from the Tropical Medicine Central Resource: Chapter 21.

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