Background and Objectives: Visceral larva migrans (VLM) is a systemic presentation of migrated nematodal larvae through human viscera. It is usually under diagnosed and not kept as a differential diagnosis of hepatic space-occupying lesions (SOL). Only a few case reports and short case series are available in the literature. Majority of these cases are still managed as amoebic or pyogenic hepatic abscesses. Here, we report six cases diagnosed as VLM.

Methods: We analyzed six patients who presented to us with non-resolving fever and pain in the abdomen and had atypical SOL on ultrasound abdomen. Appropriate blood investigations and relevant serologies were sent. Magnetic resonance imaging (MRI)/triple-phase computed tomography (CT) of the abdomen was done to characterize the lesions. The liver SOL underwent ultrasound-guided fine needle aspiration cytology (FNAC) for histopathological examination. 

Results: All the six patients had peripheral eosinophilia. MRI abdomen revealed multiple conglomerated T1 hypointense and T2 hyperintense cystic lesions with diffusion restriction, suggestive of abscesses. FNAC and histopathological examination revealed eosinophilic abscesses along with Charcot Leyden crystals. Toxocara canis serology was positive in all six patients, establishing hepatic VLM. All six patients had an excellent response to medical therapy.

Conclusion: Hepatic VLM should be contemplated as one of the differential diagnoses of multiple liver nodules or abscesses. MRI abdomen, cytology/histology, serology and clinical-radiological correlation help in diagnosis.