Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization

A case of Echinococcus granulosus hepatic hydatid cyst together with pyogenic liver abscess in a Nepali patient

Hydatidic disease (echinococcosis) is a significant health problem in Nepal. In humans, mainly involves liver and commonly remains silent without symptoms or causing only mild pressure symptomatology. However, inadequate invasive medical procedures may cause the rupture of the cyst with serious complications, anaphylactic shock and death. Herein, we report the case of a Nepali patient who had been treated of a hepatic abscess with percutaneous drainage and antibiotics in a previous hospitalization. Study by drain fluid, ultrasonography and the magnetic resonance imaging revealed the presence of an intact Hydatidic cyst in the liver concomitantly with a percutaneously draining abscess (with free hooklets and a drain tube). This emphasizes the importance of putting the Hydatidic cyst into the differential diagnosis of liver abscess, especially in non-endemic areas.

Magnetic Resonance Imaging of the Diaphragm: From Normal to Pathologic Findings

The diaphragm is a musculotendinous structure that divides the chest from the abdomen. Its motility, unintentional or voluntary, is crucial for the physiologic respiratory function due to its contribution to lung volume expansion and contraction. Therefore, diaphragmatic dysfunction may cause a respiratory failure without any pathology of the lungs. Different imaging modalities can be employed for diaphragmatic evaluation. Among all, magnetic resonance imaging (MRI) has demonstrated to be the most accurate technique in providing a morphologic and functional assessment of the diaphragm as well as information about the adjacent structures. However, its diagnostic value is still underrated and its performance is often far from the daily clinical practice. Backward, physicians and radiologists should be aware of the undoubted advantages of MRI and confident about the normal or pathologic imaging features, to avoid misdiagnosis.