A new classification of hepatic alveolar echinococcosis (HAE) calcification and biological activity using CT and PET-CT

Computed tomography angiography of liver alveococcosis: a case report

BACKGROUND

Alveococcosis, helminthiasis caused by the larvae of Alveococcus multilocularis, is characterized by the formation of parasitic nodes in the liver. This clinical case is a rare occurrence of liver alveococcosis in Uzbekistan.

CASE PRESENTATION

We present a case of a 33-year-old Asian woman from Uzbekistan who complained of discomfort in the epigastric region and right hypochondrium, along with general weakness. She had been experiencing symptoms for 5 months when a routine ultrasound examination revealed a structural formation in the liver. Patient was investigated by using contrast enhanced computed tomography (CT) and diagnosed with liver alveococcosis with multiple lesions. Patient underwent diagnostic laparotomy with obtaining gross specimen, biomaterial was examined microscopically and found that there were small fragments of fibrous tissue determined together with small groups of cystic formations and walls consisted of chitin. Moreover, contrast enhanced CT allowed us to differentiate liver alveococcosis from cavernous hemangioma, hepatocellular carcinoma, and liver metastases from unknown source.

CONCLUSION

Contrast enhanced CT plays a major role in differentially diagnosing liver alveococcosis and makes it the first line method of choice for the consideration of the future treatment and surgical interventions.

Alveolar and neotropical echinococcosis

The urgency of the problem of human alveolar and neotropic echinococcosis is due to polymorphism and the severity of clinical manifestations. The purpose and result of the work is to summarize the data available in the literature on the etiology, epidemiology, clinic, diagnosis, treatment, prevention of alveolar and neotropic echinococcosis in humans. Conclusion. The causative agent of human alveolar echinococcosis is E. multilocularis, neotropic – E. vogeli, E. oligarthra. The liver and lungs are most often affected, less often other organs of the abdominal cavity, bones, brain, spinal cord, eyes, etc. Diagnostics is carried out on the basis of a complex of clinical, instrumental, serological, molecular genetic studies. Treatment includes surgical removal of parasitic cysts and drug therapy.

A 13th-century cystic echinococcosis from the cemetery of the monastery of Badia Pozzeveri (Lucca, Italy)

OBJECTIVE

To differentially diagnose a calcified formation recovered from a 13th century AD grave from the Tuscan monastery of Badia Pozzeveri, Lucca, Italy.

MATERIALS

A calcified formation from the thoraco-abdominal region of a skeleton buried in the monastery cemetery.

METHODS

Cone Beam Computed Tomography, Scanning Electron Microscope and Energy Dispersive X-Ray Spectroscopy.

RESULTS

A hollow, calcified ovoid formation was identified as typical of a hydatid cyst, permitting the diagnosis of cystic echinococcosis in a 35-45year-old female.

CONCLUSIONS

The study reveals the circulation of the parasite Echinococcus granulosus in the region of Lucca in late medieval Tuscany.

SIGNIFICANCE

This finding is the fourth case of cystic echinococcosis from an archaeological context in Italy and provides insight into environmental conditions that appear to have affected members of a community, irrespective of social status.

LIMITATIONS

Caution and the application of multiple analyses must be exercised in the differential diagnosis to discriminate among calcified formations.

SUGGESTIONS FOR FURTHER RESEARCH

Analysis of stable isotopes of the calcified formation, such as ¹⁵N and ¹³C, in order to compare them with isotopic values of the host individual and to further confirm the parasitic origin of the find.

Alveolar Echinococcosis in Children

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.