Intrabiliary rupture of hepatic hydatid cyst: multidetector-row CT demonstration

Management of liver hydatid cyst with cystobiliary communication and acute cholangitis: a 27-year experience

PURPOSE

The rupture of the hydatid cyst into the bile ducts is a common and serious complication. The rupture can be latent or revealed after a complication such as acute cholangitis. The objective of this study was to discuss the clinical features, radiographic findings, and surgical treatment of this rare complication.

METHODS

A retrospective analysis of patients operated for acute cholangitis caused by hydatid cyst between January 1990 and May 2016 was conducted.

RESULTS

Our study included 55 cases of acute cholangitis caused by ruptured hydatid cyst: 35 were men and 20 were women. Five patients had medical history of hydatid cyst. On imaging, all patients had a dilated bile duct. In 51 cases, there was a single hydatid cyst. Hydatid cysts with fistula were located in the right lobe of the liver in 49 cases and in the left lobe in 6 cases. Seven patients underwent an emergency surgery after admission, while others were operated after 3-8 days. A conservative procedure associated with drainage was applied in 49 cases. Endoscopic treatment was performed in four cases which failed in two cases. Twenty-eight cases developed postoperative complications, among which the most common complication was biliary fistula (n - 17). There were eight cases of postoperative deaths (14.5%).

CONCLUSIONS

Liver hydatid cyst with cystobiliary communication and superadded acute cholangitis is a serious clinical problem requiring the early diagnosis and surgery in the absence of endoscopic therapy.

Hepatic hydatid disease complications: review of imaging findings and clinical implications

Hydatid disease is a zoonotic parasitic disease. The liver is the most commonly affected organ, and hepatic hydatid disease complications are not uncommon. Hydatid cyst superinfection, intrabiliary rupture, and direct rupture into the thoracic or abdominal cavities are the frequently encountered complications. Other exceedingly rare complications include rupture of the cyst into hollow viscera, abdominal wall invasion, and hepatic vasculature-related complications such as portal vein thrombosis and Budd-Chiari syndrome. These complications have variable clinical presentations and imaging findings and require different medical and surgical managements. We aim to provide a spectrum of imaging findings of different common and uncommon complications of hepatic hydatid disease with emphasis on their clinical implications.

Reconstruction of the portal vein with 64-slice spiral CT of bile duct obstruction

The aim of this study was to evaluate 64-slice spiral CT image reconstruction of the portal vein in biliary obstruction. A total of 34 clinical patients with biliary obstruction were confirmed by 64-slice spiral CT scanning with portal venous phase multi-planar reconstruction (MPR) of the biliary tract, curved planar reconstruction (CPR), thin-slab minimum-intensity projection (TS-MinIP) and maximum intensity projection (MIP). The reconstructed images were reviewed to further assess the position and cause of the biliary obstruction and to judge the accuracy of diagnosis. The 64-slice spiral CT image reconstruction of the biliary obstructions determined the causes with an accuracy of 88.2% (30/34) and identified the location of the obstruction with an accuracy of 100%. A 64-slice spiral CT reconstructed image of the portal bile duct lesions was generated, which indicated the lesion morphology, location and anatomical relationship with surrounding tissues, secondary biliary stricture and the degree of expansion and is of great clinical value in the characterization and preoperative evaluation of biliary disease.

Complications of Hydatid Cysts of the Liver: Spiral Computed Tomography Findings

Background

The purpose of this retrospective study is to evaluate the role of Spiral Computed Tomography (CT) in the detection of the complications of hepatic hydatid cysts.

Methods

During a period of 8 years and after establishing the diagnosis of numerous hydatid cysts, 7 patients with complications of hydatid cysts were found. These 7 patients (5 females, 2 males, mean age 74.2 years, range 63 - 92 years) were studied. Four of them had a known medical history of hydatid disease, while all of them presented to our department as emergency cases.

Results

They underwent Spiral CT which revealed the following complications of hydatid cysts: intrabiliary rupture in 2 patients, rupture into the peritoneal cavity resulting to peritonitis in 1 patient, contained rupture and secondary transdiaphragmatic thoracic rupture in 1 patient, rupture into both biliary tract and hepatic subcapsular space in 1 patient, rupture into the subcapsular hepatic space in 1 patient and secondary bacterial infection of the cyst resulting to abscess formation in 1 patient. All of these CT findings were surgically confirmed.

Conclusions

CT provided a rapid and accurate diagnosis in all of these cases and proved to be a very useful preoperative imaging method.

CT demonstration of pulmonary embolism due to the rupture of a giant hepatic hydatid disease

Hydatid disease can be seen anywhere in the body and presents with a variety of clinical symptoms and imaging features according to its location. In this article, computed tomography features of a giant hepatic hydatid cyst extending into the right atrium and causing pulmonary embolism are presented.