Giant hydatid cyst of the liver: a case report with literature review

Resolution of infertility following hydatid cyst removal: a case report

Introduction and importance

Human echinococcosis, also known as 'hydatid cyst,' constitutes a zoonotic parasitic disease attributed to Echinococcus granulosus or Echinococcus multilocularis. Primary afflictions occur in the liver and lungs, whilst the implication of alternative organs remains infrequent. The clinical presentation can vary, and large cysts may cause compression symptoms and complications. This case involved a 21-year-old Palestinian female with three large hydatid cysts in the liver, causing compression of adjacent structures and unique clinical manifestations.

Case presentation

A female aged 21 arrived with signs of heart palpitations, shortness of breath, tiredness, and pain in the right upper abdomen, alongside a background of infertility. During routine pre-IVF ultrasound, three liver hydatid cysts were unexpectedly found, leading to a referral to the surgical department. Laboratory tests and imaging confirmed this diagnosis. The surgery involved cyst aspiration, hypertonic saline injection, and marsupialization. Post-surgical complications were managed as they occurred. The symptoms lessened afterward, and a successful pregnancy was achieved 9 months post-surgery.

Clinical discussion

Zoonotic infection by cystic echinococcosis (CE) primarily engages the liver and lungs. The progression of symptoms is contingent upon cyst placement and resultant pressure on adjacent tissues. Diagnosis requires imaging alongside serological assays, while large cysts necessitate surgical intervention.

Conclusion

The presented case underscores the complexity of managing multiple extensive liver hydatid cysts, highlighting the necessity to consider hydatid disease amidst patients presenting with indeterminate symptoms, particularly within endemic zones. An extensive surgical strategy produced positive outcomes, illustrating the significance of prompt intervention for symptom alleviation and sustained patient health.

Giant pedunculated liver hydatid cyst causing inferior vena cava syndrome: a case report

BACKGROUND

Hydatid disease is a zoonotic infection caused by the species Echinococcus that typically affects the liver. Most liver hydatid cysts are asymptomatic at first, but as the cyst grows larger, symptoms, such as compression effects, start to appear. Ultrasonography and computed tomography scans are the widely used diagnostic tools, and surgery is considered the mainstay of treatment.

CASE PRESENTATION

We present an unusual case of a giant pedunculated hydatid cyst causing inferior vena cava syndrome in a 20-year-old male patient from the Oromo ethnic group from a rural area of the country. Abdominal ultrasound and computed tomography scan confirmed the diagnosis. Our patient underwent radical surgical resection of the cyst and had a good outcome.

CONCLUSION

Hydatid liver cyst diagnosis needs a high index of suspicion for echinococcal etiology when dealing with a giant liver cyst as it results in grave complications without any manifestations.

The impact of detailed history taking: a case report of pediatric pulmonary and hepatic hydatid disease from Ecuador

Background

Echinococcosis is a uncommon condition in pediatric patients, and encompasses alveolar and cystic forms, predominantly affecting the lungs and liver. Transmission occurs primarily through zoonotic means, such as the contamination of water and food by infected dog and other canid feces. Diagnosis can be challenging due to nonspecific symptoms that often mimic pneumonia.

The case

A 6-year-old female patient from a rural area in Ecuador who initially presented with nonspecific symptoms indicative of pneumonia. However, further investigation into socio-environmental factors led to a diagnosis of pulmonary and hepatic hydatid disease.

Conclusion

The timely and accurate diagnosis of this infectious disease enabled the patient to receive appropriate treatment and surgical intervention, leading to her complete recovery.

Human and camel cystic echinococcosis - a polyclonal antibody-based sandwich ELISA for its serodiagnosis with molecular identification

Cystic echinococcosis (CE) is an emergent neglected disease affecting human and animals in Egypt with a wide distribution and incidence. This study aimed to evaluate the use of a polyclonal antibody-based sandwich ELISA in the detection of Echinococcus granulosus antigen in human and camel sera. Hydatid cyst protoscoleces antigen (PsAg) was isolated from hydatid cysts collected from naturally infected camel livers and lungs. PsAg was used for immunization of rabbits to raise IgG polyclonal antibodies (IgG PsAb). IgG PsAb were then precipitated, purified using Protein-A Sepharose gel and labeled with horseradish peroxidase enzyme. We assayed the purity of the IgG PsAb, and the two prepared E. granulosus antigens CPsAg from camel cysts and HPsAg from human cysts by Sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The resulted protein bands of the prepared CPsAg appeared at different molecular weights: 180, 90, 68, 54, 42 and 22 kDa while, HPsAg shared with it in 4 common bands at 68, 54, 42, and 22 kDa. The purified IgG PsAb had been resolved at two bands at 52 kDa and at 32 kDa. Sandwich ELISA were performed for the detection of circulating E. granulosus antigens in sera of human (n = 183) and camels (n = 190). The purified IgG PsAb showed strong reactivity against E. granulosus infected human and camel samples and no cross reactivity neither with free-healthy negative sera nor with others parasitic diseases (Schistosomiasis, Fascioliasis, Toxoplasmosis, Ancylostomiasis for human samples and Fascioliasis, ticks' infestation, Eimeriosis, Cryptosporidiosis, Nasal myiasis, Toxoplasmosis for camel samples). The sensitivity of the assay was 98.25% (56/57) and 96.9% (31/32) against human and camel samples, respectively. Specificity was 100% in both human and camel samples. Sandwich ELISA detected CE in 33.3% (24/72) and 55.6% (50/90) random human and camel samples, respectively. Indirect ELISA, using CPsAg, was used for detection of antibodies in positive human and camels' sera and detected 96.5% (55/57) and 93.8% (30/32) of human and camel samples, respectively. In our study, Genomic DNA was extracted from protoscoleces fluid of human liver hydatid cysts to identify the Echinococcus sp. isolate based on NADH dehydrogenase subunit 1 (NAD1) gene by Polymerase Chain Reaction (PCR) and the isolate (GenBank: OP785689.1) were identified as E. granulosus sensu lato genotype. In conclusion, Sandwich ELISA technique was found to be a potent and sensitive assay for detection of hydatid antigen in both human and camel samples.

Giant Hydatid Cyst of the Liver Presenting With Severe Chest Pain and Deformity

Cystic echinococcosis (CE) is a parasitic disease caused by a larval stage (metacestode) of Echinococcus granulosus (E. granulosus), which is still endemic in many countries worldwide, despite the efforts of the World Health Organization (WHO) to reduce the disease burden in those countries. The hydatid cysts of the liver tend to grow gradually over a long period of time and may cause a variety of symptoms, either related to compression of adjacent organs or rupture. Here we report an unusual case of a giant hydatid cyst of the liver presenting to the emergency room (ER) of our hospital with chest deformity and severe chest pain, heralding impending rupture. Considering the very large size of the cyst (26×20 cm) and severe pain, we deemed expeditious surgery to be the best option. Upon surgery, the cyst contents were evacuated, biliary connections were ligated, and measures were taken to prevent the dissemination of the disease into the abdominal cavity. Closed drainage was used since the patient had almost no omentum. The patient received albendazole pre- and postoperatively. The patient was discharged in good condition after one week in the hospital.