Radiologymovies - a cura della Dimamovies Srl

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VIDEO US: Transabdominal ultrasound shows a large cystic mass in left lobe of the liver containing multiple daughter cysts separated by the hydatid matrix (a material with mixed echogenicity ). The matrix represents hydatid fluid containing membranes of broken daughter vesicles, scolices, and hydatid sand. Hyperechoic contour in the cyst wall

VIDEO CT : CT scan shows the typical peripheral location of the daughter vesicles within the mother cyst and the partial calcification of the pericyst..

Classification of ultrasound images in cystic echinococcosis proposed by the Informal Working Group on Echinococcosis of the World

Health Organization: Cystic lesions of uncertain etiology (CL) and echinococcal cysts in the active (CE1, CE2), transitional (CE3), and inactive (CE4 and CE5) stages.

CLINICAL CASES
PRESENTATION

A 72 year Italian old woman with history of vague pain in the right upper quadrant, and urticaria. Clinical profile : palpable mass with right upper quadrant Laboratory data: Eosinophilia

DIFFERENZIAL DIAGNOSIS

COMPLEX PYOGENIC ABSCESS.
HEMORRAGIC CYST
INFECTED CYST
CYSTIC METASTASES
BILIARY CYSTOADENOCARCINOMA

FINAL DIAGNOSIS :

HEPATIC ECHINOCOCCUS CYST

DISCUSSION

Hydatid disease is a severe and common parasitic disease caused by larval stage of Echinococcus granulosus

Is endemic to the Mediterranean basin and other sheep-raising areas ( Africa , South America , Australia ; New Zealand ).

Ultrasonography and computed tomography, the most important diagnostic tools, are helpful for determining the complications and planning treatment

Imaging findings in hepatic hydatid disease depend on the stage of cyst growth .

In 2003, the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) proposed a standardized ultrasound classification based on the active-transitional-inactive status of the cyst as suggested by its sonographic appearance.

TRATTAMENT :

The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy.

Surgery is still the treatment of choice and can be performed by the conventional or laparoscopic approach ( Segmentale or lobar hepatectomy.

Percutaneous drainage and treatment of the cyst with hypertonic saline or alcohol seems to be a good alternative to surgery in selected cases.

Medical Therapy : Albendazole ; Mebendazole

REFFERENCES

Gharbi HA, Hassine W, Brauner MW, Dupuch K . Ultrasound examination of the hydatic liver. Radiology 1981; 139: 459-463

Haddad M, Birjawi G, Khouzami R, Khoury N, El-Zein Y, Al-Kutoubi A. Unilocular hepatic echinococcal cysts: sonography and computed tomography findings. Clin.Radiol 2001; 56: 746-750

Brunetti E.; Filice C. ; Echinococcosis Hydatid Cyst ; e-medicine.com ; Dicembre 4, 2006).

WHO Informal Working Group on Echinococcosis: Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis.
Bull World Health Organ 1996; 74(3): 231-42

Kumar et al. Hydatid cyst of liver; Postgrad Med J.2003; 79: 113-114

Shah DS, Parikh H, Shah B, Banuprakash S, Shah J. Imaging appereances of hydatid cyst. Indian J Radiol Imag ing [serial online] 2006 [cited 2008 May 28];

Filice C, Pirola F, Brunetti E, Dughetti S, Strosselli M, Foglieni CS. A new therapeutic approach for hydatid liver cysts. Aspiration and alcohol injection under sonographic guidance. Gastroenterology 1990; 98: 1366-1368

Anil T. Ahuja , et a l. ; Diagnostic Imaging Ultrasound ; Amirsys Inc 2007

HEPATIC ECHINOCOCCUS CYST

Author:
Danilo Sirigu MD;
Stefano Puddu MD **;
Servizio di Radiologia, Azienda Ospedaliera Brotzu, Cagliari

Luglio 2008
www.sonoworld.org

E-mail: info@radmovies.it

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Clinic cases:

> Primary adenocarcinoma of the duodenum

> Virtual colonscopy

> HEPATIC ECHINOCOCCUS CYST

> Budd Chiari Syndrome

>THE GRAFT INTOLERANCE SYNDROME ( GIS )

> Cellular Fibroma of the ovary

> Von Meyenburg complexes

>SPONTANEOUS BACTERIAL PERITONITIS