Intestinal pathology and site specificity of Neoechinorhynchus carpiodi Dechtiar, 1968, in quillback, Carpiodes cyprinus (Lesueur), from Dauphin Lake, Manitoba, was investigated. Neoechinorhynchus carpiodi elicits the formation of a nodule at the point of proboscis attachment. Over 98% of the worms were attached in sections 6-8 of the intestine. Fish had clusters of 1-8 nodules, cluster size increased with worm burden, and the volume of nodules increased with worm numbers. Nodule number, size, and pathology was related to intensity of infection and to depth of proboscis penetration. Three types of pathology were noted. Type I nodules had few worms and the proboscides were attached in the lamina propria; Type II nodules harbored more worms and the proboscides penetrated to, but not through, the stratum compactum; and Type III nodules had the greatest numbers of N. carpiodi and proboscides penetrated through the stratum compactum. Hyperplasia, vascularization, and collagen deposition were extensive, especially in Type III nodules. An epithelium-lined channel was present in most nodules. Type III nodules were most anterior (75% of the time), harbored the greatest proportion of immature worms regardless of cluster size, and had more gravid females. The largest nodules (Type III pathology) were well vascularized, long-lasting, and appeared to be the preferred microhabitat for the parasite.