Hydatid disease from head to toe

Imaging of primitive pleural hydatidosis in children: A case report

Hydatidosis, caused by the larval form of the parasite Echinococcus granulosus, is a rare condition, especially in pediatric patients, with pleural involvement being exceedingly uncommon. We report a case of primary pleural hydatidosis in a 9-year-old child, emphasizing the importance of various imaging techniques in establishing an accurate diagnosis.

Isolated hydatid cyst in the medial rectus muscle: unveiling a rare orbital occurrence

BACKGROUND

Orbital hydatid disease, while rare, should be included in the differential diagnosis of unilateral proptosis, particularly in endemic areas. Accurate diagnosis and comprehensive management are essential for effective treatment and favorable long-term outcomes.

CASE PRESENTATION

A 12-year-old boy presented with a one-month history of diplopia and left-sided proptosis. A CT scan revealed a cystic mass within the left medial rectus muscle. Surgical intervention confirmed the presence of a hydatid cyst following cyst rupture and irrigation with hypertonic saline. The patient underwent a two-month course of albendazole therapy. Initially, the patient experienced persistent exotropia and diplopia, but at the three-year follow-up, he exhibited no diplopia or proptosis and only mild residual exotropia.

CONCLUSION

This case underscores the importance of considering orbital hydatid cysts in the differential diagnosis of unilateral proptosis in endemic regions. Heightened awareness, accurate diagnosis, and a tailored therapeutic approach, including surgical removal and antiparasitic treatment, are crucial for successful management and improved long-term outcomes.

Magnetic resonance imaging characteristics of musculoskeletal hydatid disease

BACKGROUND

Hydatid disease is a parasitic infection seen in endemic areas. Musculoskeletal hydatid disease is rarely reported.

PURPOSE

To describe the magnetic resonance imaging (MRI) features of musculoskeletal hydatid disease and to highlight the specific findings in the diagnosis of hydatid cysts.

MATERIAL AND METHODS

The MRI scans of 29 cases diagnosed as musculoskeletal hydatid disease between 2000 and 2022 were retrospectively analyzed. The localization, size, appearance (unilocular or multilocular), signal characteristics, rim sign, presence of internal septa and membrane, and gadolinium enhancement pattern of hydatid cysts were evaluated.

RESULTS

A total of 29 patients diagnosed with hydatid cyst were included in the study. Of the lesions, 18 were localized in bone and 11 were in soft tissue. The bone hydatid cysts on MRI showed heterogeneous low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images in the medullary bone. In 15/18 patients, there was also cortical destruction and extension into the adjacent soft tissue planes. In 8/11 cases where the cyst was located in muscle tissue, the "cyst or cysts within a cyst" appearance was observed on MRI. The rim sign was observed in 7/11 cases and the "water lily" sign was noted in 2/11 cases.

CONCLUSION

MRI provides valuable information for the diagnosis of hydatid disease with its distinctive imaging features. Knowledge of the different patterns of hydatid cysts on MRI may be helpful in the diagnosis of this disease.

The multifaceted musculoskeletal hydatid disease

Musculoskeletal hydatid disease is rare and can be located anywhere but most commonly the bone and muscles of the spine, pelvis, then the lower limbs. Imaging is essential for its diagnosis, performing the pre-therapeutic assessment, guiding possible percutaneous treatments, and providing post-therapeutic follow-up. Musculoskeletal hydatidosis can take several forms that may suggest other infections and tumors or pseudotumors. MRI and CT are superior for its diagnosis but ultrasound and radiography remain the most accessible examinations in developing countries where this parasitosis is endemic. In this review, we provide an overview of this disease and describe its different imaging patterns in soft tissue and bone involvement that should be sought to support the diagnosis.

Hydatid cyst of the brainstem: The rarest of the rare locations for echinococcosis

Hydatidosis, caused by the larval stage of Echinococcus granulosus, is a zoonotic disease typically affecting the liver and lungs. Cerebral localizations are rare, especially in the brainstem. We present a case of a 9-year-old boy with a brainstem hydatid cyst. The patient exhibited progressive walking difficulties and limb impairment. MRI revealed a brainstem mass consistent with a hydatid cyst. Due to the lesion's size and location, surgical intervention was necessary. The cyst was decompressed and removed without complications, followed by albendazole treatment. Postoperative recovery was uneventful, and the patient showed no signs of recurrence after 2 years. This case highlights the importance of early diagnosis, precise surgical techniques, and thorough postoperative care in managing rare cerebral hydatid cysts.

Hydatid cyst at unusual locations: Report of three cases

INTRODUCTION

Hydatidosis is an anthropozoonosis due to the development in humans of the larval form of Echinococcus granulosus and is endemic in many countries of the Mediterranean region such as Morocco.

CASES PRESENTATION

We report three cases of hydatid cyst at unusual locations such as the peritoneum, and the retroperitoneum.

DISCUSSION

Hydatid disease usually involves the liver (75 %), the lungs (15.4 %), and the spleen (5.1 %). Almost any anatomic location can be the host site of the parasitic cysts.

CONCLUSION

Multiple locations of hydatid cyst often pose a problem of differential diagnosis. Surgery is the mainstay of treatment.

Renal Hydatid Cyst: Diagnostic Quandaries and Surgical Strategies

Renal hydatid cyst, an uncommon manifestation of Echinococcus granulosus infection, presents a diagnostic challenge due to its asymptomatic nature. Here, we report the case of a 34-year-old male who presented with intermittent left flank pain, abdominal fullness, and passage of whitish clots in urine. Physical examination revealed a palpable 15 cm × 11 cm hard mass extending from the left hypochondrium to the left lumbar region. Ultrasonography and contrast-enhanced computed tomography identified a 15 cm Bosniak type 3 complex cystic lesion arising from the left kidney, causing hydronephrosis and hydroureter. The patient underwent a left nephrectomy, and a histopathological examination confirmed a renal hydatid cyst. This case highlights the diagnostic difficulty in differentiating renal hydatid cysts from other renal lesions. Despite suggestive radiological findings, conclusive diagnosis remains elusive, particularly in solitary complex renal cysts. Awareness of renal hydatid cysts in the differential diagnosis is crucial for appropriate management.

Circulating free DNA as a diagnostic marker for echinococcosis: a systematic review and meta-analysis

Introduction

Echinococcosis is a chronic zoonotic disease caused by tapeworms of the genus Echinococcus. The World Health Organization (WHO) has identified encapsulated disease as one of 17 neglected diseases to be controlled or eliminated by 2050. There is no accurate, early, non-invasive molecular diagnostic method to detect echinococcosis. The feasibility of circulating free DNA as a diagnostic method for echinococcosis has yielded inconclusive results in a number of published studies. However, there has been no systematic evaluation to date assessing the overall performance of these assays. We report here the first meta-analysis assessing the diagnostic accuracy of cfDNA in plasma, serum, and urine for echinococcosis.

Methods

We systematically searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WeiPu databases up to 17 January 2024, for relevant studies. All analyses were performed using RevMan 5.3, Meta-DiSc 1.4, Stata 17.0, and R 4.3.1 software. The sensitivity, specificity, and other accuracy indicators of circulating free DNA for the diagnosis of echinococcosis were summarized. Subgroup analyses and meta-regression were performed to identify sources of heterogeneity.

Results

A total of 7 studies included 218 patients with echinococcosis and 214 controls (156 healthy controls, 32 other disease controls (non-hydatid patients), and 26 non-study-targeted echinococcosis controls were included). Summary estimates of the diagnostic accuracy of cfDNA in the diagnosis of echinococcosis were as follows: sensitivity (SEN) of 0.51 (95% CI: 0.45-0.56); specificity (SPE) of 0.99 (95% CI: 0.97-0.99); positive likelihood ratio (PLR) of 11.82 (95% CI: 6.74-20.74); negative likelihood ratio (NLR) of 0.57 (95% CI: 0.41-0.80); diagnostic ratio (DOR) of 36.63 (95% CI: 13.75-97.59); and area under the curve (AUC) value of 0.98 (95% CI: 0.96-1.00).

Conclusion

Existing evidence indicates that the combined specificity of circulating cfDNA for echinococcosis is high. However, the combined sensitivity performance is unsatisfactory due to significant inter-study heterogeneity. To strengthen the validity and accuracy of our findings, further large-scale prospective studies are required.Systematic review registrationThe systematic review was registered in the International Prospective Register of Systematic Reviews PROSPERO [CRD42023454158]. https://www.crd.york.ac.uk/PROSPERO/.

A rare case report: Primary isolated hydatid cyst of the spleen- diagnosis and management

INTRODUCTION AND IMPORTANCE

Hydatid disease is widespread in agricultural regions and globally. Tunisia is notably affected in the Mediterranean. Although liver involvement is common, splenic hydatidosis is rare, with incidence worldwide ranging from 0.5 % to 4 %. Surgery, particularly total or partial splenectomy, remains the primary treatment. We present a unique case of isolated splenic hydatid cyst successfully managed by total splenectomy.

CASE REPORT

A 40-year-old Tunisian farmer presented with persistent pain in the left hypochondrium for 4 months, accompanied by a sensation of heaviness. Physical examination revealed splenomegaly, and laboratory tests showed a positive Indirect Hemagglutination test for Echinococcus sp. (titer >160). Thoracoabdominal CT scan revealed a 10 cm splenic hydatid cyst. Surgery involved total splenectomy via an extended left subcostal approach. Postoperative recovery was uneventful, with successful albendazole therapy and vaccination following splenectomy. During biannual follow-up, the patient remained asymptomatic and did not present with any other hydatid localization.

CLINICAL DISCUSSION

Splenic hydatid cyst is rare. Diagnostic and therapeutic advancements are crucial for its management. Therapeutic options include total splenectomy, spleen preservation, and percutaneous interventions. However, these approaches carry unique risks and benefits. Close monitoring and individualized management are essential to ensure optimal outcomes.

CONCLUSION

Diagnosis of splenic hydatid cysts is challenging due to their often asymptomatic nature and lack of specific signs. With no standardized management protocols available, personalized treatment strategies are essential. Further research is crucial to improve treatment approaches and outcomes for this rare yet clinically important condition.

Ex-situ liver resection for complex Echinococcus multilocularis infection: a case report

Echinococcus multilocularis, the fox dwarf tapeworm, causes alveolar echinococcosis (AE), a critical and life-threatening condition. A radical surgical approach represents the only curative option. In this case study, we present a 37-year-old man diagnosed with extensive hepatic AE requiring ex-situ extended right-sided liver resection including the caudate lobe and retro-hepatic vena cava. The left liver segments were auto-transplanted with reconstruction of the left hepatic vein and an inferior vena cava graft. In the post-operative course, the patient developed a bile leak, which was successfully managed with endoscopic stent intervention. He was discharged after a three-week hospitalization. Medical treatment with albendazole was initiated preoperatively and continued postoperatively.

Characterization of research trends and prospects on hepatic echinococcosis over the past forty years: a bibliometric analysis

BACKGROUND

The distribution of hepatic echinococcosis (HE) is extensive, significantly impacting public health and economic development. Therefore, analyzing global collaboration networks and tracking developmental trends over the past four decades are crucial. This study aimed to demonstrate collaboration in the field of HE and explore key topics and future directions.

MATERIALS AND METHODS

Bibliometric analyses were conducted using CiteSpace, Bibliometrix package of R, and VOSviewer software on HE-related studies from the Web of Science Core Collection published before 1 August 2023.

RESULTS

This study identified 2605 records published in 196 journals by 9860 authors from 2607 institutes in 90 countries. Publications significantly notably increased in 2021. Developing countries like Turkey and China made notable contributions, while developed countries like the USA had higher average citation rates. The largest nodes in every cluster of the collaboration network were Hacettepe University, Tehran University, Xinjiang Medical University, Salford University, and the University of Pavia, and the top-producing authors were Wen H, Vuitton DA, Gottstein B, and Craig PS. Keyword co-occurrence analysis suggested that surgical techniques and novel drugs targeting combined immune checkpoints are the main therapeutic approaches in the future.

CONCLUSION

Although developing countries had significantly contributed to publications on HE, the citation rate for individual articles from developed countries was significantly higher. Additionally, advancements in surgical techniques and novel drugs targeting combined immune checkpoints may emerge as the next research focus and developmental direction.

Suitability of Fourier transform infrared microscopy for the diagnosis of cystic echinococcosis in human tissue sections

Cystic echinococcosis (CE) is a global health concern caused by cestodes, posing diagnostic challenges due to nonspecific symptoms and inconclusive radiographic results. Diagnosis relies on histopathological evaluation of affected tissue, demanding comprehensive tools. In this retrospective case study, Fourier transform infrared microscopy was explored for detecting and identifying CE through biochemical changes in human tissue sections. Tissue samples from 11 confirmed CE patients were analyzed. Archived FFPE blocks were cut and stained, and then CE-positive unstained sections were examined using Fourier transform infrared microscopy post-deparaffinization. Results revealed the method's ability to distinguish echinococcus elements from human tissue, irrespective of organ type. This research showcases the potential of mid-infrared microscopy as a valuable diagnostic tool for CE, offering promise in enhancing diagnostic precision in the face of the disease's complexities.

Encysted Odyssey: A Clinical and Pictorial Analysis of Hydatid Cysts From Head to Toe

INTRODUCTION

Cystic echinococcosis, a zoonotic disease caused by the larval form of Echinococcus granulosus, predominantly affects the liver and lungs, with humans acting as accidental hosts.

METHODS

Our retrospective study at the Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, included 187 histopathologically or serologically proven cases. The mean age of presentation was 49.4 years.

RESULTS

Liver involvement was most prevalent, accounting for 83.4% (n=156) of cases, followed by sporadic involvement of other organs such as the mesentery, spleen, pancreas, thalamus, kidney, lung, spine, and omentum. Characteristic diagnostic features observed on imaging included peripheral calcifications in 33% of cases, internal septations in 25% (n=47), dense calcifications in 15% (n=29), daughter cysts in 6% (n=11), and floating membranes in 5% (n=10). Among hepatic lesions, 90% (n=141) were showing involvement of a single lobe. Notably, 78% (n=110) of lesions were limited to the right lobe, 21% (n=30) to the left lobe, and 1% (n=1) to the caudate lobe. The most affected hepatic segment was segment VIII, while the least common was segment I (caudate lobe). Complications were identified in 13% (n=25) of cases of hepatic hydatidosis.

CONCLUSIONS

The findings of our study emphasize the systemic nature of E. granulosus infection which can affect various organs in the body. It also illustrates the invaluable insights imaging provides for timely and accurate diagnosis of hydatid disease.

Therapeutic effect of curcumin nanoemulsion on cystic echinococcosis in BALB/c mice: a computerized tomography (CT) scan and histopathologic study evaluation

BACKGROUND

This study aimed to determine the therapeutic efficacy of curcumin nanoemulsion (CUR-NE) in mice infected with Echinococcus granulosus sensu stricto protoscoleces.

METHODS

Forty-two inbred BALB/c mice were divided into seven groups of six animals each. Six groups were inoculated intra-peritoneally with 1500 viable E. granulosus protoscoleces, followed for six months and used as infected groups. The infected groups were named as: CEI1 to CEI6 accordingly. The 7th group was not inoculated and was named cystic echinococcosis noninfected group (CENI7). CEI1 and CEI2 groups received 40 mg/kg/day and 20 mg/kg/day curcumin nanoemulsion (CUR-NE), respectively. CEI3 received nanoemulsion without curcumin (NE-no CUR), CEI4 received curcumin suspension (CUR-S) 40 mg/kg/day, CEI5 received albendazole 150 mg/kg/day and CEI6 received sterile phosphate-buffered saline (PBS). CENI7 group received CUR-NE 40 mg/kg/day. Drugs administration was started after six months post-inoculations of protoscoleces and continued for 60 days in all groups. The secondary CE cyst area was evaluated by computed tomography (CT) scan for each mouse before treatment and on the days 30 and 60 post-treatment. The CT scan measurement results were compared before and after treatment. After the euthanasia of the mice on the 60th day, the cyst area was also measured after autopsy and, the histopathological changes of the secondary cysts for each group were observed. The therapeutic efficacy of CUR-NE in infected groups was evaluated by two methods: CT scan and autopsied cyst measurements.

RESULTS

Septal calcification in three groups of infected mice (CEI1, CEI2, and CEI4) was revealed by CT scan. The therapeutic efficacy of CUR-NE 40 mg/kg/day (CEI1 group) was 24.6 ± 26.89% by CT scan measurement and 55.16 ± 32.37% by autopsied cysts measurements. The extensive destructive effects of CUR-NE 40 mg/kg/day (CEI1 group) on the wall layers of secondary CE cysts were confirmed by histopathology.

CONCLUSION

The current study demonstrated a significant therapeutic effect of CUR-NE (40 mg/kg/day) on secondary CE cysts in BALB/c mice. An apparent septal calcification of several cysts revealed by CT scan and the destructive effect on CE cysts observed in histopathology are two critical key factors that suggest curcumin nanoemulsion could be a potential treatment for cystic echinococcosis.

Seronegative Bilateral Pulmonary Hydatid Cysts in a 15-Year-Old Boy From Pakistan: Report of a Rare Case

Hydatid disease, attributed to the tapeworm Echinococcus granulosus, poses a significant health threat in regions where it is endemic. Here, we present a case involving a 15-year-old boy from rural Pakistan who initially sought medical attention due to a persistent cough and hemoptysis. Despite initially testing negative for serological markers, imaging studies revealed well-defined cysts in both lungs. Confirmation of the diagnosis was achieved through histopathological examination. Management includes albendazole therapy and surgical excision of the cyst. Our case underscores the diagnostic challenges associated with seronegative cases and underscores the importance of considering hydatid disease in endemic regions, irrespective of typical serological markers. This report enhances understanding regarding the clinical presentation, diagnostic approach, and management strategies for pulmonary hydatid cysts.

A 16-year-old adolescent with a history of minor abdominal trauma diagnosed with a giant isolated primary splenic hydatid cyst: a case report

Introduction

Hydatosis is a zoonotic parasitic disease caused by echinococcosis larval infection. South America, Africa, the Middle East, South Europe, India, and Australia are endemic to this disease. Splenic involvement is a rare and complicated hydatid disease presentation. A splenic hydatid cyst is an infrequent clinical occurrence, even in regions where the disease is endemic.

Case presentation

A 16-year-old male, having a background of mild abdominal trauma and non-resolving dull abdominal pain attended a paediatric surgical outpatient office and following a thorough examination, was diagnosed with a giant solitary isolated splenic hydatid cyst. Subsequently, the patient received albendazole and underwent total splenectomy, necessitated by the considerable size of the cyst, classified as a giant.

Clinical discussion

Splenic involvement of hydatid disease is a rare presentation (0.5-8%.). With the initial clinical finding often involving the accidental discovery of a palpable mass, the most frequently reported symptoms and signs include the presence of a palpable mass, fever, dull pain, or splenomegaly. Ultrasound and computed tomography are the most helpful tools for evaluating focal splenic diseases. The preferred treatment involves the use of antihelminthic drugs such as albendazole or mebendazole in conjunction with splenectomy. Total splenectomy is the preferred approach and is associated with decreased hospital stay, reduced healthcare costs, and a lower likelihood of recurrence.

Conclusion

in endemic areas, in patients with splenic cysts, hydatidosis should be contemplated.

Delayed Surgical Treatment of a CE1 Lung Cyst Resulting in Pericystectomy of CE4 Cyst

Lung is the second most common locationof cystic echinococcosis (CE), after the liver. Diagnosis of lung CE is often incidental, and clinical manifestations depend on the location and size of the cyst, the most common being chest pain, shortness of breath, expectoration of fragments of endocyst, and haemoptysis. Surgery is the primary treatment, with a minor role for medical therapy. Delayed diagnosis and treatment may have important consequences. We present a case of lung CE in whichsurgical treatment was delayed due to the first wave of COVID-19. Since surgery could not be performed immediately, the patient was kept on albendazole and the cyst stage moved from CE1 to CE3a, to CE4, eventually requiring a more aggressive pericystectomy instead of the commonly performed endocystectomy. The clinical and imaging characteristics of a rare CE4 cyst of the lung are reported.

The Impact of Pulmonary Hydatid Cyst Rupture on COVID-19 Symptom Severity

BACKGROUND

Co-infection with other microorganisms such as parasites in patients with COVID-19 can affect the clinical outcome and require prompt diagnosis and appropriate therapy.

CASE PRESENTATION

We present a case of an adult male with chest pain, dyspnea, cough, diplopia, and anorexia who was confirmed to have acute COVID-19 pneumonia. 2 weeks prior to admission, a hydatid lung cyst was identified on examination, but the patient refused surgery. Thoracoabdominal computed tomography (CT) revealed a rupture of the lung hydatid cyst and co-infection with COVID-19. The patient has prescribed a treatment protocol for COVID-19 and albendazole. Despite measures taken to manage severe inflammation and decreasing blood oxygen levels, the patient required admission to the intensive care unit (ICU) and intubation. After approximately 3 weeks of hospitalization, the patient was successfully extubated and discharged uneventfully from the hospital. Oral albendazole was prescribed for follow-up treatment.

CONCLUSION

Our case highlights the importance of considering hydatid cysts in the differential diagnosis of patients with COVID-19, especially those living in endemic areas.

A case of pediatric primary osteolytic extradural and complicated hydatid cyst revealed by a skull vault swelling

Hydatidosis is a parasitic infestation whose etiological agent is the larva of the cestode Echinococcus granulosus. It is a zoonosis, and the human being behaves as an accidental intermediate host in the parasitic cycle with pediatric predominance. The most frequent clinical presentation is hepatic, followed by pulmonary, with cerebral hydatidosis being extremely rare. Imaging is characteristic, generally dealing with single cystic lesion, usually unilocular and less frequently multilocular, located mainly intraaxially. Extradural hydatid cyst, whether primary or secondary, remains very rare or even exceptional. The primary disease remains extremely rare, and its clinical picture is related to the number, size, and location of the lesions. Infection within these cerebral hydatid cysts remains an extremely rare occurrence, and only few cases were reported previously in the literature. The authors report the nosological review of the clinical, imaging, surgical, and histopathological records of a pediatric primary osteolytic extradural and complicated hydatid cyst in a 5-year-old North African male patient coming from a rural area who presented for progressive onset of a painless left parieto-occipital soft swelling without any neurological disorder with good outcomes after surgery. The authors report this case due the fact that it had not been documented before in the pediatric population and to the success of the specialized treatment.

Giant non-parasitic splenic cyst: a case report

BACKGROUND

Splenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas.

CASE PRESENTATION

We reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst.

CONCLUSIONS

Detecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts.

Bone Echinococcosis Mimicking Malignancy on FDG PET

ABSTRACT

MRI revealed a thoracic vertebrae lesion in a 40-year-old woman with back pain. She was referred to our institution; MRI demonstrated a mass from the second to the fifth thoracic vertebra and compression fractures. CT revealed a splenic mass, multiple pulmonary nodules, and low-density masses in the liver. 18 F-FDG PET/CT showed increased uptake (SUV max , 10.6) in the peripheral rim of the thoracic vertebra mass, with central parts showing lower uptake than the peripheral rim. The splenic mass exhibited increased accumulation (SUV max , 4.8). The thoracic spine lesion was fixed; a biopsy was performed. Alveolar echinococcosis was confirmed immunologically. Alveolar echinococcosis can present with bone lesions. It must be differentiated from malignancy.

A Large Cyst in an Unlikely Location: The Interventricular Septum

•A large cardiac cyst was discovered in an extremely rare location: the IVS. •Pre- and postcontrast imaging is essential in the evaluation of a cystic mass. •When identifying a cardiac cyst, malignancy and infection must be considered. •The benefit of excising a cardiac cyst is unclear in an asymptomatic older patient.

Sensitive detection of specific cell-free DNA in serum samples from sheep with cystic echinococcosis

BACKGROUND

Developing more sensitive methods for the diagnosis of echinococcosis is essential. In this study PCR assay for sensitive detection of specific cell-free DNA (cfDNA) of Echinococcus granulosus sensu lato in the sera of the sheep naturally infected with echinococcosis was investigated.

METHODS

To extract cfDNA from 35 infected sheep, the modified phenol-chloroform method was used for two different volumes (0.5 and 2 ml) of serum samples. From each extracted sample, two DNA volumes (5 and 10 μl) were amplified using both standard PCR and semi-nested PCR targeting NADH dehydrogenase subunit I.

RESULTS

Standard and semi-nested PCR on 0.5 ml of serum samples detected Echinococcus DNA in 8 and 12 out of 35 sheep, respectively; however, using 2 ml of serum samples, they detected 24 and 27 samples. By increasing the volume of template DNA, the PCRs could detect 29 and 33 out of 35 samples. The results were confirmed by sequencing of randomly selected PCR amplicons and comparing them with GenBank databases.

CONCLUSIONS

Larger volumes of serum for DNA extraction, greater volumes of DNA template for PCR, and employing a semi-nested PCR protocol, increased the sensitivity of PCR to 95%. This approach can also be applied to the diagnosis of echinococcosis in humans.

The silent invader: a case of intrapericardial hydatid cyst with exceptional pulmonary artery involvement

A 70-year-old woman was referred to our cardiology department for the management of dyspnoea. Cardiovascular examination revealed a loud P2, with no sign of right-sided heart failure. Chest X-ray showed a convex left medium cardiac border and a double contour along the right cardiac border. Transthoracic echocardiogram revealed a cystic mass attached to the right ventricle apex. Computed tomography scan showed cyst with fluid density on the apex of the right ventricle; and a honeycomb-like aspect cyst with partial occlusion in the left pulmonary artery. Cardiac magnetic resonance imaging revealed the presence of hydatic intrapericardial cyst that compresses the right ventricular apex; associated with intraluminal left pulmonary artery cyst. Hydatic serology was positive. The patient refused surgery and was discharged on a regimen of Albendazole. She has been followed up closely with a good outcome.

Osseous hydatid disease: A mimic of other skeletal pathologies

Hydatid disease is still endemic in several regions worldwide including Morocco, and is caused in most cases by the larval form of 2 species of the tapeworm Echinococcus: E. granulosus and E. multilocularis. Primary hydatid disease of the bone without systemic involvement is rare. The disease has a silent clinical evolution until it reaches complicated stages. Complications may include pathological fracture, neural deficit, infection, and fistulization of the abscess. Preoperative diagnosis is based on clinical history, imaging findings, and serological tests, which lack high sensitivity and specificity. Although the interpretation of imaging studies can prove to be very confusing because the bone changes evolve with time, and the nonspecificity of these findings often leads to a mistaken diagnosis. The diagnosis requires a high index of suspicion, especially in patients who reside in or travel to sheep-raising areas where hydatid disease is endemic. A high index of suspicion is necessary for the diagnosis, especially in patients that live in or travel to sheep-raising areas where hydatid disease is endemic. The treatment of choice remains surgical, following the principles of a locally malignant lesion. Chemotherapy (albendazole alone or in combination with praziquantel) is indicated when surgery is not possible or as an adjuvant treatment. The prognosis is often poor. We report the case of a 28-year-old woman with long-standing pain in the left hip joint in which the imaging findings were thought of as being either tuberculous or neoplastic. The result of a CT-guided biopsy concurred with an unexpected diagnosis of a hydatid cyst. This case highlights that in the absence of a high index of suspicion for echinococcal infection, the semblance of imaging findings of hydatid disease in the bone to those of other skeletal pathologies can lead to misinterpretation.

Hydatid cyst involving the mandible ramus

Parasitic infections rarely involve the oral and maxillofacial regions and pose a diagnostic challenge when they do. Hydatid cysts are parasitic cysts caused by Echinococcus granulosus. Intraosseous involvement is observed in 3% of cases, of which only 2-6% are in the maxillofacial region. A scientific literature search revealed only seven cases involving the mandible. We report a rare case in a 16-year-old female patient who presented with facial asymmetry and well-defined radiolucency of the ramus. Our findings will help in understanding the diagnostic issues caused by non-specific presentation and difficulties in suspecting such a rare diagnosis as echinococcosis of the oral or maxillofacial region. A thorough systemic investigation is essential as 20-30% of these cases show multiorgan involvement.

Posterior Mediastinal Hydatid Cyst with Spine and Chest Wall Involvement

Hydatid cyst, which is caused by Echinococcus larvae, is a worldwide zoonotic disease which can affect virtually any organ in the body. Although the liver and lungs are the most commonly affected, it can occur in other parts of the body. Mediastinal hydatid cysts are incredibly rare, but imaging is crucial to diagnose and determine the extent of involvement and complications. In this article, we present a case of posterior Mediastinal hydatid cyst with adjacent chest wall and spinal involvement, diagnosed through chest CT and histopathology.

Intact Excision of a Mesenteric Pseudocyst

Mesenteric cysts are detected in all age groups with almost equal incidence in both genders. Although a rare abdominal growth, it is commonly found in the fifth to seventh decades of life. These are mostly small (asymptomatic) with a 3% chance of malignant transformation. With the increase in the size of the cyst, nonspecific complaints of abdominal pain, distention, discomfort, nausea, vomiting, flatulence, constipation, or diarrhea may develop. Owing to the varied presentation and lack of pathognomonic clinical, laboratory, or imaging findings, these are difficult to diagnose. The subtype mesenteric pseudocyst is even rarer with a reported incidence of less than 1 out of 250,000 hospital admissions and can be found anywhere along the mesentery from the duodenum to the rectum. Etiology is either traumatic or infectious. Incidental diagnosis during abdominal imaging or laparotomy is common. However, it warrants immediate surgical intervention when infected or ruptured. Complete excision of the cyst is the treatment of choice. Here, we report an interesting case of a middle-aged gentleman who had been repeatedly evaluated for a tense abdomen with exudative ascites. Following decompression, he presented to us with a large obliquely mobile mass in the abdomen. The diagnosis was made by clinical and radiological findings and confirmed by histopathological examination of the intact, excised specimen post-laparotomy.

Primary cervical hydatid cyst: A rare case report

INTRODUCTION AND IMPORTANCE

Hydatid cyst is a zoonotic parasitic disease caused by Echinococcus granulosis. Occurrence in the head and neck is quite uncommon even in endemic areas. The diagnosis of an isolated cystic neck mass is still a challenge due to the presence of similar congenital cystic lesions and benign tumors in the neck. Imaging is useful, but sometimes they cannot identify a definitive diagnosis. The treatment of choice is exclusively surgical excision, combined with chemotherapy. Histopathology confirms the definitive diagnosis.

CASE PRESENTATION

We present a case of an 8-year-old boy with no history of surgery or trauma, who complained of an isolated left posterior neck mass since one year. All radiological items lead to suspect a cystic lymphangioma. Excisional biopsy under general anesthesia was done. The cystic mass was totally resected and the diagnosis was further confirmed by histopathology.

CLINICAL DISCUSSION

Cervical hydatid cyst is mostly a misdiagnosed condition, majority of hydatid cyst cases are asymptomatic and vary on the basis of their locations. The differential diagnosis includes cystic lymphangioma, branchial cleft cyst, bronchogenic, thoracic duct, esophageal duplication cysts, pseudocysts and benign tumors.

CONCLUSION

Isolated cervical hydatid cyst is rarely reported yet, it must be considered in any cases of cystic cervical mass, particularly in endemic areas. Imaging modalities are sensitive in diagnosing cystic lesions, yet sometimes they cannot identify the exact etiology of the lesion. Furthermore, Prevention of hydatid disease is more favorable than surgical excision.

Primary intramuscular and intermuscular Echinococcal disease of the iliopsoas and sartorius muscles: A case report

Hydatid disease is a parasitic infection caused by the Echinococcus tapeworm. Classically, Echinococcal lesions are slowly growing cystic masses with daughter cysts. The most common sites of disease are the liver in 75% of cases and lungs in 15% of cases. This report covers a case of a patient from Southeast Europe with primary extrahepatic hydatid disease in and along the left iliopsoas and sartorius muscles. Retroperitoneal and soft tissue Echinococcus infection without liver involvement is extremely rare and creates a diagnostic challenge for clinicians and radiologists, especially in nonendemic areas.

Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project

The neglected zoonosis cystic echinococcosis affects mainly pastoral and rural communities in both low-income and upper-middle-income countries. In Europe, it should be regarded as an orphan and rare disease. Although human cystic echinococcosis is a notifiable parasitic infectious disease in most European countries, in practice it is largely under-reported by national health systems. To fill this gap, we extracted data on the number, incidence, and trend of human cases in Europe through a systematic review approach, using both the scientific and grey literature and accounting for the period of publication from 1997 to 2021. The highest number of possible human cases at the national level was calculated from various data sources to generate a descriptive model of human cystic echinococcosis in Europe. We identified 64 745 human cystic echinococcosis cases from 40 European countries. The mean annual incidence from 1997 to 2020 throughout Europe was 0·64 cases per 100 000 people and in EU member states was 0·50 cases per 100 000 people. Based on incidence rates and trends detected in this study, the current epicentre of cystic echinococcosis in Europe is in the southeastern European countries, whereas historical endemic European Mediterranean countries have recorded a decrease in the number of cases over the time.

Body Imaging of Bacterial and Parasitic Zoonoses: Keys to Diagnosis

Zoonotic infections, which are transmitted from animals to humans, have been a substantial source of human disease since antiquity. As the human population continues to grow and human influence on the planet expands, humans frequently encounter both domestic and wild animals. This has only increased as deforestation, urbanization, agriculture, habitat fragmentation, outdoor recreation, and international travel evolve in modern society, all of which have resulted in the emergence and reemergence of zoonotic infections. Zoonotic infections pose a diagnostic challenge because of their nonspecific clinical manifestations and the need for specialized testing procedures to confirm these diagnoses. Affected patients often undergo imaging during their evaluation, and a radiologist familiar with the specific and often subtle imaging patterns of these infections can add important clinical value. The authors review the multimodality thoracic, abdominal, and musculoskeletal imaging findings of zoonotic bacterial (eg, Bartonella henselae, Pasteurella multocida, Francisella tularensis, Coxiella burnetii, and Brucella species), spirochetal (eg, Leptospira species), and parasitic (eg, Echinococcus, Paragonimus, Toxocara, and Dirofilaria species) infections that are among the more commonly encountered zoonoses in the United States. Relevant clinical, epidemiologic, and pathophysiologic clues such as exposure history, occupational risk factors, and organism life cycles are also reviewed. Although many of the imaging findings of zoonotic infections overlap with those of nonzoonotic infections, granulomatous diseases, and malignancies, radiologists' familiarity with the imaging patterns can aid in the differential diagnosis in a patient with a suspected or unsuspected zoonotic infection. ^© RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

Hydatid Disease: A Pictorial Review of Uncommon Locations

Hydatid disease is a zoonotic infection caused primarily by the tapeworm parasite, Echinococcus granulosus. It is considered an endemic disease in the Mediterranean region.  In about 90% of cases, hydatid cysts are found in the liver and lungs; however, any other organ in the body may be affected, particularly in endemic areas. When encountering cystic lesions in these areas, the physician should always keep hydatid disease as a possible diagnosis in mind. To avoid life-threatening conditions such as anaphylactic shock or pressure effect on vital organs, timely diagnosis, and proper management are critical. When a rare site is involved, hydatid disease should be diagnosed using a combination of serologic assays and imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). These imaging modalities can also be used to determine the extent of the disease and assess possible complications. Here, we present a pictorial review of typical imaging manifestations of hydatid cysts in unusual sites. Being aware of these imaging features will assist physicians in making an accurate, timely diagnosis and subsequently, providing optimal management.

Diagnosis of echinococcosis by detecting circulating cell-free DNA and miRNA

INTRODUCTION

Diagnosis of echinococcosis is difficult and usually performed based on clinical findings, imaging, and serological test. However, all of them have limitations, especially in follow-up approaches.

AREAS COVERED

Detection of cell-free DNA (cfDNA) and micro-RNA (miRNA) is currently a hot topic for diagnosis of echinococcosis diseases. For detecting cell-free DNA in echinococcosis patient's samples such as sera, some techniques are based on next-generation sequencing (NGS), DNA-deep sequencing, some are based on PCR-based methods, and a few works related to the detection of miRNA for the diagnosis of human echinococcosis.

EXPERT OPINION

In the detection of cell-free DNA in echinococcosis patient' samples, NGS and DNA-deep sequencing have shown high level of sensitivity, but are not suitable for routine clinical examination as they are expensive and inaccessible in the majority of endemic areas. However, PCR-based methods have shown a sensitivity of about 20-25%. To improve the sensitivity of these tests, improving the DNA extraction method, designing appropriate primers for detecting short-length fragments of circulating DNA, using a higher volume of a serum sample, and application of more sensitive PCR methods are recommended. In the field of miRNA detection, further works are recommended.

Primary Chest Wall Hydatid Disease: A Case Report with Multimodality Imaging Findings

Primary chest wall hydatid cyst is a very rare disease in endemic areas. This case report describes a 22-year-old male patient with a 3-year history of chronic left chest pain. He had a history of close animal contact in childhood. Chest computed tomography (CT) scan showed a left upper posterior paravertebral cystic mass with peripheral and intrinsic calcifications. Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) scan showed no significant FDG uptake. Magnetic resonance imaging (MRI) showed a left paravertebral cystic mass with daughter cysts and a peripheral low T2 wall, compatible with hydatid disease. Medical treatment was started, and a follow-up MRI showed rupture of hydatid cysts. The patient underwent surgical resection, and a hydatid disease diagnosis was confirmed by histopathologic examination. During the postoperative hospital course, the patient developed pneumothorax which was successfully treated with a surgical procedure. The patient was discharged with medical treatment (albendazole). In conclusion, this case highlights the importance of considering hydatid disease in the differential diagnosis of chest wall cystic masses, especially in endemic regions, and the value of multimodality imaging in diagnosis and treatment planning.

A rare case of hydatid cyst of the neck with concurrent pulmonary hydatid disease

Echinococcosis, commonly known as hydatid disease, is a zoonotic infection caused by dog tapeworm Echinococcus granulosus. Hydatid disease of the head and neck region is scarcely reported even in endemic areas. We herein report a case with with neck swelling and respiratory symptoms subsequently diagnosed to have disseminated echinococcosis of the neck and left lung.

Histopathological and immunological study of rats liver hydatid cysts isolated from human, sheep, goat and cows

In endemic places, liver hydatidosis is a life-threatening health issue. Many consequences such as hepatomegaly, infiltration with inflammatory cells and histopathological changes might arise as a result of liver hydatidosis. This study aimed to look into pathogenic changes in the livers of the rats that experimentally infected with hydatid cysts. These hydatid cysts were isolated from naturally infected humans, sheep, goats and cows. Liver hydatid cysts were collected from the main abattoir of Al-Muthanna province while human hydatid cysts were collected from Al-Hussein Teaching Hospital in Al-Muthanna province. The hydatid cysts were grossly and histology examined for inspection of hydatid cysts. The in vivo experiments were done by injection of hydatid protoscoleces or sand (fluid) in rats intraperitoneally. The results showed that the gross signs were same in all infected livers which range from paleness, hepatomegaly, hemorrhage and calcification. The hydatid cysts isolated from sheep and goat livers were highly fertile compared to others isolated from humans and cows. Injection of hydatid protoscoleces and hydatid fluid isolated from sheep and goat livers in rats induced the highest immune response compared to that isolated from humans and cows. The liver sections of rats that were injected with human, goat and sheep hydatid protoscoleces and fluids showed hyperplasia in the bile duct, aggregation nonnuclear cells with congested blood vessels. While liver sections of rats were received goat hydatid fluid, cow hydatid protoscoleces and hydatid fluid showed normal liver tissue. These findings suggested that the immunogenicity of hydatid materials is different according to the host and the component of hydatid cysts.

An unusual case report on intracranial hydatid cyst with intraventricular extension

Background

We report an interesting case of a primary isolated intraventricular and intracranial hydatid cyst in 20-year-old female that mimicked bleeding cystic tumor presenting as intraventricular hemorrhage with hydrocephalus.

Case presentation

Patient presented with headache and giddiness for 1 month. On magnetic resonance imaging, there was multiloculated multi-cystic lesion in left lateral ventricle and adjacent left periventricular deep white matter. Lesion was causing compression of the body of the left lateral ventricle with temporal horn dilatation and midline shift of 17–18 mm toward right side. On investigation, it was diagnosed intracranial hydatid cyst with intraventricular extension. Patient underwent complete removal of cerebral hydatid cyst. Follow-up postoperative computed tomography scan done which revealed no residual hydatid cyst.

Conclusion

In this case, larvae of echinococcus might have passed through capillaries of liver and lungs and entered systemic circulation reaching brain. Intracerebral hydatid cysts are rare and hence, dangerous if the diagnosis and treatment is not prompt. Intracerebral hydatid cysts have slow growth rate with late-stage symptoms, morbidity and mortality are high. So, take home message is whenever intracranial cystic lesion are found on magnetic resonance imaging hydatid cyst with possible intracranial extension should be considered in differential diagnosis.

A giant isolated primary splenic hydatidosis: A case report

Introduction

and importance: Hydatid cyst disease is caused by Echinococcus tapeworm and is one of the major health problems in endemic regions like Nepal. The cases of splenic hydatidosis are quite rare and giant isolated primary splenic hydatidosis is even rarer. The patients present with vague symptoms or no symptoms at all. Here we report a case of isolated splenic hydatid cyst. So, we should think the differential diagnosis of splenic hydatidosis in any abdominal case of endemic regions.

Case presentation

A 27-year-old female presented with left-side abdominal pain for the past 7 months without any particular attraction. Abdominal ultrasound showed a well-defined cystic mass on the upper pole with low-level internal floating debris. Contrast Enhanced CT scan showed well defined cystic lesion measuring about 10.8 × 9.6 × 8.5 cm in the upper pole of the spleen with an exophytic component and minimal homogenous wall enhancement. Laparoscopic Splenectomy was done and albendazole for 3 weeks was prescribed after all the patient was completely normal.

Clinical discussion

In this case, the optimal treatment of giant isolated splenic hydatidosis was splenectomy and prescription of albendazole.

Conclusion

We believe in any abdominal case of the endemic region, the hydatid cyst of the spleen should be taken as one of the differential diagnoses and should be managed appropriately before the complication arises.

Breast hydatid cyst presented as a fluctuant painless lump mimicking galactocele: A case report

Hydatid disease is a zoonosis caused by the Echinococcus species. The liver and lungs are where it generally seen, with breast involvement being extremely uncommon. This is a case of a woman aged 28 years who presented with a progressive painless swelling on the left breast, which was fluctuant and nontender, detected on the upper outer quadrant. The cytologic evaluation yielded a crystal-clear fluidal aspirate composed of a few laminated metachromatic materials and the mass sonographically appeared as an anechoic cystic mass having a double-layered wall with posterior acoustic enhancement. A radical pericystectomy was performed after the preoperative diagnosis of breast hydatid cyst was entertained, and the diagnosis was later confirmed by histopathology. Although isolated breast hydatid cysts are uncommon, they can happen and may mimic other cystic and solid masses of the breast clinically. Thus, radiologic assessment with cytopathologic correlation is imperative for precise preoperative diagnosis and to minimize the risk of intraoperative complications.

Prevalence of Cystic Echinococcosis Genotypes in Iranian Animals: A Systematic Review and Meta-Analysis

Background

Cystic echinococcosis is considered a public health problem that if left untreated can have dangerous consequences for the person. The disease is caused by Echinococcus granulosus sensu lato larvae. The main risk factors for this parasitic infection are habitat, direct contact with dogs, use of raw vegetables, and use of unwashed vegetables. The most important factors affecting the prevalence of HCD are economic, occupational, agricultural, educational, and factors related to public health and cultural habits of the general public in that geographical area.

Objectives

The purpose of this study was to investigate the prevalence of the types of cystic echinococcosis genotypes (E. granulosus sensu stricto (G₁-G₃) and E. Canadensis (G₆ and G₇)) in livestock in Iran.

Method

This systematic review was conducted, using Medline/PubMed, Scopus, Web of Sciences, and Google Scholar databases, to identify studies of cystic echinococcosis in animals published from 2010 to April 14, 2021. Finally, 28 studies were selected for meta-analysis, which was analyzed using Stata software version 14. The cystic echinococcosis prevalence with 95% confidence intervals of animals was synthesized using the random effect model. Heterogeneity was evaluated and in cases where the I² index was higher than 75%, subgroup analysis was performed according to the types of animals.

Result

The highest prevalence of cystic echinococcosis infection was related to G₁ genotype (P = 0.91 (95% CI = 0.84, 0.97)) and the prevalence was related to G₂ genotype (P = 0.07(95% CI = 0.00, 0.18)). The results of the subgroup analysis showed that in the G₁ genotype the highest prevalence was observed in Goats and Buffaloes with P = 1 (95% CI = 0.96, 1) and P = 1 (95% CI = 0.97, 1), in the G₃ and G₆ genotypes the highest prevalence was observed in camels with P = 0.50 (95% CI = 0.31, 0.69), and P = 0.45 (95% CI = 0.22, 0.69), respectively.

Conclusion

The cystic echinococcosis genotypes vary from region to region or from country to country and also from host to host, and according to the results, it should always be stopped in areas where the prevalence of such genomes suitable for livestock as well as human food sources to prevent infection of livestock and thus human exposure to cystic echinococcosis.

Primary muscular hydadit cyst: Case report

Primary hydatid disease of the skeletal muscle without systemic involvement is rare. Since the infection appears on clinical examination to be a soft-tissue tumor. It is important to have a preoperative radiological evaluation, particularly with magnetic resonance imaging (MRI) to avoid biopsy or improper cyst management during surgery. We present a unique case of a primary hydatid cyst manifesting as an expanding soft-tissue mass in a 31-year-old woman's left thigh with magnetic resonance imaging revealed a very suggestive aspect of hydatid cyst in the adductor muscles and shows the interaction between cysts and nearby structures. The cyst was surgically removed, and macroscopic and microscopic histopathological examinations confirmed the diagnosis of muscular hydatidosis.

Paediatric pulmonary echinococcosis: A neglected disease

Echinococcosis is a worldwide public health problem causing considerable paediatric morbidity and mortality in endemic areas. The presentation of cystic echinococcosis (CE) varies by age. Unlike adults, where hepatic involvement is common, pulmonary CE is the dominant site in the paediatric population. Pulmonary cysts are typically first seen on chest X-ray, either as an incidental finding or following respiratory symptoms after cyst rupture or secondary infection of the cyst. In children, pulmonary cysts have a broad differential diagnosis, and a definitive diagnosis relies on the combination of imaging, serology, and histology. In countries with high infectious burdens from diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), the diagnosis is additionally challenging, as atypical infections are more common than in developed countries. Pulmonary CE is treated with a combination of surgery and chemotherapy.

Primary hydatid cyst of adrenal gland: Case report

The hydatid disease is an anthropozoonose caused in humans by a larval form of Echinococcus granulosus. Adrenal gland is a rare and unsymptomatic site. We illustrate the case of a 46-year-old patient, admitted for left hypochondrial pain with back radiation. The CT reveals a multiloculated, cystic mass on the left adrenal gland, which contains septae and a calcified wall.

Isolated breast hydatid cyst: Imaging features

Hydatid cyst (HC) of the breast is a rare entity, even in endemic areas. We report the radiologic features of an isolated breast HC in a 50-year-old woman. Imaging findings may mimic other common breast lesions, but specific imaging features help establish an accurate diagnosis to adapt therapeutic management.

Imaging of hydatid cyst of kidney, ureter and urinary bladder

Renal hydatid is an uncommon finding, reported in less than 5% patients with hydatid infection. Hydatid involvement of ureter and urinary bladder is an even rarer entity. Renal hydatid is typically unilateral, solitary and arises from cortex. It is essential to be aware of the imaging features of the hydatid cyst for proper diagnosis. Knowledge of the imaging features of various stages is essential since treatment decision is based on cyst stage. Hydatid cyst can mimic several entities both benign and malignant. We present a pictorial review to illustrate the radiological imaging features of hydatid disease involving kidney, ureter and bladder region and its complications.

Disseminated alveolar echinococcosis in a patient diagnosed by metagenomic next-generation sequencing: A case report

Background

Alveolar echinococcosis (AE) is a parasitic zoonosis with high mortality and disability rates. Diverse clinical manifestations and mimicking of differential diagnoses such as tuberculosis and malignancy pose a diagnostic dilemma. With the rapid development of molecular diagnostic techniques in recent years, metagenomic next-generation sequencing (mNGS) has become an attractive approach for the etiological diagnosis of infectious diseases.

Case presentation

we report a case of 51-year-old Chinese Tibetan male presented with 3-year low-back pain and 4-month discomfort in the right upper quadrant of the abdomen. He had been in good health. He was diagnosed with tuberculosis and was given anti-tuberculosis treatment a month prior to the visit, but the symptoms were not relieved. Abdominal computerized tomography (CT) revealed a hypodense lesion with uneven enhancement in the liver, and two ring-enhancing cystic lesions in the right abdominal wall. Lumbar spine enhanced MRI showed lesions of mixed density with uneven enhancement in the L1 vertebra and paraspinal tissue. The pathological results of the liver biopsy revealed parasitic infection and possibly echinococcosis. The metagenomic next-generation sequencing (mNGS) of the puncture fluid of abdominal cysts using Illumina X10 sequencer revealed 585 sequence reads matching Echinococcus multilocularis. Disseminated AE was diagnosed. Albendazole (400 mg, twice daily) was used, and the patient was in stable condition during follow-up.

Conclusions

mNGS may be a useful tool for the diagnosis of AE. The case would help clinicians to improve their diagnostic skills.