Diagnosis and surgical treatment of renal hydatid disease: a retrospective analysis of 30 cases

Large seminal vesicle hydatid cyst in a young male: A case report with technical modification approach

INTRODUCTION

Hydatid disease (HD) rarely affects the genitourinary system, comprising only 2-4 % of all hydatid infections. While kidney involvement is more common, seminal vesicle HD is rarely reported.

CASE PRESENTATION

We describe a 39-year-old man with an incidentally found large pelvic hydatid cyst arising from the seminal vesicle. Despite adhesion to adjacent organs, we successfully drained the cyst content through a small hole of the cyst wall in a sterile setting. The patient remained symptom-free, maintained potency and urinary continence and the lesion decreased in size, significantly after six-month follow-up.

DISCUSSION

Surgical excision remains the preferred treatment for seminal vesicle hydatid disease (HD). During surgery, extreme caution must be exercised to prevent cyst rupture or irritation of adjacent organs. While complete excision is ideal, in cases where the cyst adheres to adjacent organs, partial cystectomy or cyst drainage should be considered.

CONCLUSION

Cyst drainage proves effective, especially in cases of adjacent organ invasion.

Diagnostic Problem in a Child With an Isolated Renal Hydatid Cyst: A Case Report

Cystic hydatid disease is a parasitic disease caused by the larvae of the small tapeworm Echinococcus granulosus. It is still a serious public health problem in endemic regions such as the Mediterranean basin, especially in the Balkans. Usually, the complaints caused by the cysts are non-specific and there are rarely abnormalities in routine laboratory tests. The most common is the involvement of the liver. The frequency of isolated kidney involvement, especially in a child, is uncommon. We describe a rare pediatric case of an isolated renal hydatid cyst presenting with a urinary tract infection-like clinical presentation, leading to misdiagnosis and delayed treatment.

Isolated renal hydatid cyst

INTRODUCTION AND IMPORTANCE

Hydatid disease, is a parasitic disease caused by the larval stage of the cestode Echinococcus granulosus. The Liver and lungs are the commonly affected organs but rarely kidney can be affected. Patient with primary renal hydatid may present with nonspecific symptoms or may be diagnosed incidentally. Imaging and serology are useful for diagnosis. The best therapy is surgery.

CASE PRESENTATION

This case is reported to discuss a 35-year-old female presented with complaints of left side flank pain and swelling. The abdominal US and CECT show renal cyst, which was nonspecific. She underwent an open surgical exploration and cystectomy plus partial pericystectomy done. Post-operative serology test show Echinococcus IgG positive. Postoperatively, the patient had an uneventful recovery and discharged with Albendazole therapy for 8 weeks.

CLINICAL DISCUSSION

Renal hydatid cyst is rare, accounting for less than 2 to 3 % of all hydatid disease. Renal hydatid cysts can remain asymptomatic for many years and then can be discovered incidentally. The diagnosis and staging of renal hydatid cysts rely heavily on imaging and serology. Hydatid disease is primarily treated surgically.

CONCLUSION

A high index of suspicion should be maintained, especially in endemic areas, to ensure timely and accurate diagnosis of renal hydatid cyst. Surgical excision remains the treatment of choice, with appropriate preoperative and postoperative anthelminthic therapy. Long-term follow-up is crucial to monitor for recurrence and associated complications.

A pictorial review of genitourinary infections and inflammations

Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.

Bilateral renal hydatid disease associated with complex urolithiasis: A case report

INTRODUCTION AND IMPORTANCE

The association of bilateral renal hydatid cysts and complex urolithiasis is unprecedented. We herein report the case of a patient presenting with both diseases.

CASE PRESENTATION

A 56-year-old female patient with a history of chronic kidney disease presented with right flank pain. Imaging revealed bilateral kidney cystic lesions associated with right spontaneous large ureteric streinstrasse and multiple calyceal stones. The right sided mass was exophytic and measured 56 mm and the left sided lesion measured 35 mm. Semi rigid right ureteroscopy was performed along with a right partial nephrectomy and a right pyelotomy which allowed for renal and ureteral stone extraction. Histopathology report concluded to a hydatid cyst. The decision was to monitor the left-sided lesion.

CLINICAL DISCUSSION

The association of bilateral renal hydatidosis and right urolithiasis is unprecedented in literature. The lesion presented a differential diagnosis problem with a cystic malignancy. Thus, the decision was to perform a right partial nephrectomy. The combination of ureteroscopy and a single right flank incision was sufficient to treat the renal lesion as well as to obtain stone free status. Once the histopathological report concluded to a hydatid cyst, the decision was to monitor the left sided lesion. A more aggressive approach could be proposed however it would have been detrimental to the patient's renal function.

CONCLUSION

When presented with an association of bilateral renal masses and urolithiasis, a methodical step-by-step approach is necessary in order to treat both diseases while minimizing patient morbidity.

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.

Primary Renal Hydatid in Children

Isolated renal hydatid disease, caused by the larvae of the parasitic tapeworm Echinococcus granulosus is a rare phenomenon and accounts for only 2% of all reported cases. The authors report a case of a 12-year-old female who presented with right flank pain. Initial abdominal ultrasound revealed a complex cystic mass in the upper pole of the right kidney. A contrasted CT scan better defined it as a well-circumscribed cyst with multiple thin septations. Laboratory investigations showed eosinophilia and a positive IgG Echinococcus serology. Considering these radiological and laboratory findings, a tentative diagnosis of primary renal hydatid was made. With perioperative antihelmintic therapy, the authors used a combination of an open puncture-aspiration-injection-reaspiration technique pericystectomy to manage the isolated renal hydatid. Renal hydatid can easily be misinterpreted pre-operatively for more sinister renal cystic pathology, including cystic renal cell carcinoma. An accurate pre-operative diagnosis requires a high index of suspicion, especially in endemic regions. Surgical therapy, with perioperative antihelmintic therapy, offers the best chance of cure.

Case Report: Total Nephrectomy for Renal Hydatidosis

Cystic echinococcosis, known as hydatidosis, is a parasitic zoonosis caused by the larvae of Echinococcus granulosus. Renal hydatidosis is a very rare condition, representing 1% to 2% of cases. We present an 18-year-old patient who, after suffering a trauma, experienced severe lower back pain and persistent gross hematuria disproportionate to the trauma. Ultrasonography and tomography revealed cystic images compatible with right renal hydatidosis and hemoperitoneum. In addition, rapid clinical deterioration was observed with decreased hematocrit, leading to lumpectomy with abundant cysts inside and outside the right kidney, without viable parenchyma. Therefore, a total nephrectomy was performed. The patient was discharged with albendazole treatment. Pathological anatomic analysis confirmed the diagnosis of hydatidosis. Surgery remains the best therapeutic option. The use of ultrasonography improves the early detection of zoonosis, especially in pediatric patients, and favors the use of more conservative therapeutic techniques.

Isolated Renal Hydatid Cyst in a 6-Year-Old Boy: A Case Report

Hydatid cyst (HC) is a parasitic infection transmitted by oral ingestion of Echinococcus granulosus eggs. Isolated kidney involvement is extremely rare. It is even less common in children. We present a case of isolated renal HC in a 6-year-old boy from Şanlıurfa, southeast Turkey who complained of abdominal pain and distension. Cystectomy was performed with a flank incision using the extraperitoneal approach. No recurrence was detected in the postoperative 6-month follow-up. There are not enough data about the efficacy of medical treatment in renal HC. Therefore, medical treatment should be considered pre- and post-operatively to prevent dissemination, rather than being used as a primary treatment. Kidney-sparing surgery should be the first choice in patients with isolated renal HC. However, nephrectomy is recommended for nonfunctioning kidneys, large cysts thought to be connected with the collecting system, and cysts with suspicious tumor. In societies where HC disease is endemic, renal HC should be considered in children with cysts located in kidney, even if the indirect hemagglutination test is negative.

Challenges in treatment of renal echinococcosis with gross hydatiduria and unsalvageable kidney: a case report

Introduction

Renal echinococcosis is of rare occurrence, and although often asymptomatic, it can present with various mild to drastic presentations, of which hydatiduria is pathognomonic. Diagnosis can be preliminarily established by imaging, and treatment is primarily surgical. We present a patient with renal echinococcosis treated successfully with exclusive antiparasitic pharmacotherapy after refusing surgery despite extensive renal involvement. We hope through this report to help establish future solid guidelines regarding this uncommon therapeutic approach.

Case presentation

This is a case of a 49-year-old Syrian shepherd presenting with flank pain and passage of grape-skin-like structures in urine. A diagnosis of renal echinococcosis with hydatiduria and significant parenchymal destruction was established based on exposure history, positive serology, imaging findings, and renal scintigraphy. After proper counseling, the patient refused nephrectomy and was therefore started on dual pharmacotherapy (albendazole and praziquantel) and is having an uneventful follow-up and a satisfactory response to treatment.

Conclusion

This case embodies the daily challenges physicians navigate as they uphold the ethical principles of their practice and support their patients’ autonomy while delivering the best standards of care and consulting the scientific evidence. Although surgery is the cornerstone of renal echinococcosis treatment, treating physicians should be prepared to tackle situations where surgery cannot be done and offer the best next available option for patients who refuse surgery. As data on exclusive pharmacotherapy are limited, future research should thoroughly investigate the efficacy of this uncommon approach and outline reliable recommendations, facilitating future clinical decision-making in this avenue.

Isolated renal hydatid cyst misdiagnosed and treated as a cystic renal tumor: a diagnostic pitfall

Background

The hydatid disease is a parasitic infestation caused by the larval stage of Echinococcus granulosus. The renal location of this infectious disease is uncommon compared to hepatic or pulmonary ones. Most patients remain asymptomatic for years and hydatiduria is the only pathognomonic clinical symptom. We report a rare case of renal hydatid cyst misdiagnosed and treated as a renal tumor.

Case presentation

A 45-year-old woman with no significant medical or surgical history presented with left lumber pain with hematuria. Magnetic Resonance Imaging (MRI) displayed a left renal mass with cystic and solid components, showing discreet enhancement, classified as Bosniak IV. The diagnosis of renal malignant tumor was made. The patient underwent a lumbotomy. Intraoperatively, the mass was adherent to the perirenal fat and seemed to invade the adrenal gland. An enlarged left nephrectomy with surrenalectomy was performed. The gross specimen showed a superior polar renal cyst (9 × 7 × 6cm). The cyst had a thick wall and contained multiple internal smaller cysts recalling the appearance of the hydatid cyst. The microscopic study showed a cyst wall consisting of acellular eosinophilic laminated membrane lined by a thin germinal layer from which merge daughter cysts. This cyst wall is surrounded by a dense fibrovascular tissue with chronic inflammatory cells. The diagnosis of renal hydatic cyst was made.

Conclusion

Although the renal hydatid cyst is relatively rare, this diagnosis must be considered in patients with renal cystic masses, especially endemic countries. Preoperative diagnosis is challenging, especially in type IV cysts which can mimic a renal tumor and lead to overtreatment.

Comparison of Laparoscopic and Open Surgery in the Treatment of Renal Hydatid Cysts

Background: To compare the efficacy, safety, and long-term results of laparoscopic and open approaches in patients undergoing surgery for renal hydatid cyst. Materials and Methods: The files of 36 patients who were surgically treated in our clinic and with diagnosis of renal cyst hydatid confirmed pathologically were reviewed. According to the surgical technique applied, the patients were divided into two groups as open (group 1) or laparoscopic (group 2) partial pericystectomy. Oral albendazole was given 10 mg/kg/day (in two divided doses) for 4 weeks preoperatively and for three cycles of 4 weeks at 1-week intervals after surgery in all patients. Demographic characteristics, laboratory and imaging findings, operation times, hospitalization times, complications, intraoperative bleeding amounts, and recurrence rates were statistically compared in both groups. Results: Open partial pericystectomy was performed in 21 patients in group 1, and laparoscopic transperitoneal partial pericystectomy was performed in 15 patients in group 2. Operation time and intraoperative bleeding amount in group 1 and group 2 were 119.6 ± 17.1/116.1 ± 17.6 minutes and 125.7 ± 27.8/113.9 ± 19.2 mL, respectively. There was no statistically significant difference between these values (P = .557, P = .167, respectively). Hospitalization duration of both groups was 5.9 ± 1.4/3.6 ± 0.7 days, respectively. Hospitalization duration in group 2 was statistically significantly shorter (P < .001). No recurrence occurred during postoperative follow-up in either group. Conclusions: In the treatment of renal hydatid cysts, laparoscopy, which is a minimally invasive approach, can be technically applied with the same principles as open surgery and has a similar efficacy and safety profile for short- and long-term results.

Isolated renal hydatid disease: laparoscopic approach to an uncommon entity (case report)

Hydatidosis is a parasitic disease, endemic in various parts of the World. It frequently involves liver and lungs and, rarely, other organs as well. Isolated renal hydatidosis is a rare entity that accounts for less than 3% of all hydatid cases. Surgery remains the mainstay of treatment. We hereby report a case of isolated renal hydatid cyst involving left kidney that was managed by laparoscopic approach.

A Rare Case of Renal Pelvic Hydatid Cyst Masquerading as Renal Calculi

Background: Hydatid disease of urinary tract is most common in the kidney. In kidney, hydatid cysts are most commonly found in the renal parenchyma. Isolated hydatid cysts in the renal pelvis are extremely rare with only three cases reported in the literature. Case Presentation: We present a case of isolated hydatid cysts in the renal pelvis masquerading as renal pelvic calculi, which were diagnosed during surgery and confirmed on histopathology. Conclusion: Hydatid cysts can masquerade as renal calculi. Preoperative modalities may miss the correct diagnosis. Histopathology in suspected cases can confirm the diagnosis so that proper chemotherapy can be offered to patient to avoid recurrence.

Medical treatment for an isolated renal multilocular hydatid cyst in an elderly: a case report

BACKGROUND

Almost all cases of renal hydatid cysts need surgical intervention for treatment. We report a case of isolated renal hydatid cyst treated successfully only with medical therapy.

CASE PRESENTATION

This case is a 79-year-old veterinarian presented with right flank pain, hydatiduria and positive echinococcus granulosus serology. A 70*50 mm cyst with daughter cysts in mid-portion of right kidney on presentation was changed into a 60*40 mm cyst without daughter cysts at last follow-up. Due to patient's refusal of surgery, our patient received medical treatment including praziquantel and albendazole. After completion of first round of treatment, recurrence occurred and the same treatment was repeated. At last, the cyst became inactive and calcified with negative serology and no clinical symptoms under medical treatment.

CONCLUSION

The treatment of choice in renal hydatid cyst is surgery; although there are some reports about the efficacy of medical treatments for hydatid cysts but lower rates of recurrence and higher efficacy put surgery in a superior position compared to medical approaches. Our case showed relative success of medical treatment, despite the presence of a large multilocular renal involvement. Thus, medical therapy without surgery can be considered in very particular cases with isolated renal hydatid cysts.

Case report - Primary renal echinococcal infection

Renal echinococcal infection is an uncommonly encountered infection in North America but is endemic in many parts of the world. With increasing migration, it is conceivable that practicing Canadian physicians will see more patients presenting at various stages of infection. Herein, we describe an unusual presentation of primary renal echinococcal infection and describe current diagnostic, as well as medical and surgical management strategies.

Cystic echinococcosis: a 10-year experience from a middle-income country

Cystic echinococcosis (CE), or hydatid disease, is a neglected tropical disease (NTD) afflicting one million people globally. This study aims to elucidate the presentation, treatment and outcomes of the disease in Pakistan. A review of charts of 225 patients (median age = 42.3 years) with CE admitted at Aga Khan Hospital, Karachi during 2007-2017, was carried out. Abdominal pain was present in 34.7% followed by fever in 26.2%. There were 142 (63.1%) cases of hepatic cysts and 55 (24.4%) of pulmonary hydatid cysts. Combined surgical and medical therapy was given to 130 (57.8%) patients. Surgery only was performed in 23 (10.2%) patients, medical therapy only was given to 35 (15.6%) patients, and puncture, aspiration, injection and reaspiration (PAIR) with medical therapy was given to 15 (6.7%) patients. Recurrence occurred in 14 (6.2%) patients and mortality in 7 (3.1%) patients. Owing to its non-specific presentation, a high index of suspicion is required to diagnose and treat CE in a timely manner.

The Maverick Disease: Cystic Echinococcosis in Unusual Locations: A Ten Year Experience from an Endemic Region

Background Cystic echinococcosis (CE) is a neglected tropical disease which affects more than 1 million people globally, causing a loss of 1-3 million disability-adjusted life years (DALYs) and a financial burden of US$ 3 billion annually.The two most commonly involved organs are the liver and the lungs with involvement in 75% and 5 -15% of cases respectively. The rest of the body can be involved in up to 10% of cases. In this study, we aim to explore the presentation, treatment and outcomes of CE in unusual locations. Methods Retrospective review of charts of 225 patients of CE admitted at Aga Khan Hospital, Karachi from 2007-2017 was done. Demographic information, date of admission, clinical presentation, laboratory and radiological findings, histopathology reports (where applicable), treatment course and outcomes were noted. Results CE occurred in the liver in 146 (64.9%) patients, in the lungs in 55 (24.4%) patients and in unusual locations in 24 (10.7%) patients. Primary involvement of unusual locations was seen in 22 (91.7%) cases. Amongst the 24 patients with disease in unusual locations, 13 (54.2%) were males and 11 (45.8%) were females and the median age of these patients was 43 years. Fever and dyspnea were the most common presenting complains, occurring in 5 (20.8%) patients each followed by epigastric abdominal pain and weight loss occurring in 3(12.5%) patients each. Spleen was the most common unusual location for CE with four cases (16.7%) of splenic involvement occurring, followed by cardiac, spinal and mediastinal involvement occurring in three (12.5%) patients each. Other unusual locations included the abdominal cavity, bones, breast, kidney, seminal vesicle, brain, adrenal glands and the inguinal region. The treatment courses employed were a) medical, consisting of oral albendazole use(400 mg twice daily), b) surgical c) combined (medical plus surgical) therapy. Combined surgical and medical therapy, was the most common modality employed, with it being given to 14 (58.3%) patients. Surgery only was performed in 5 (20.8%) patients while medical therapy only to 3 (12.5%) patients. Resolution of the disease was seen in 19 (79.2%) patients on follow up imaging. Recurrence occurred in 4 (16.7%) and mortality in 1 patient. Two patients (8.3%) were lost to follow up. Conclusions CE can be challenging to diagnose especially when it occurs in unusual locations. CE must be included in the differential diagnosis of a cystic lesion in any organ of the body, especially in endemic areas, to ensure timely diagnosis and treatment, to prevent morbidity and mortality associated with chronicity of the disease.

First Reported Case of Echinococcal Disease on a Renal Graft Successfully Treated With Albendazole

Echinococcal disease is an endemic disease for eastern Mediterranean countries. Various types of kidney involvement have been reported. Here, we report the first case of echinococcal disease on a transplanted kidney in a patient who was successfully treated with albendazole alone. The patient (a 38-year-old female) was evaluated for elevated creatinine levels 7 months after receiving a living-donor allograft. Standard immunosuppression therapy protocols were applied. Tacrolimus level was normal, and the patient was compliant with treatment. Creatinine level was 1.91 mg/dL (baseline: 1.2 mg/dL); proteinuria level was 1300 mg/day. The graft was found to be normal, as evaluated with standard sonographic methods. A kidney biopsy was performed, which showed that part of the cortical parenchyme was infiltrated by echinococcal protoscolices with hooklets. Because there were no cysts present on the graft, we concluded that disease was at an early stage. The patient was given albendazole for 3 months. After therapy, all echinococcal structures disappeared. Her creatinine level dropped to baseline, and proteinuria resolved. Echinococcal disease can affect transplanted kidneys. Albendazole is a valuable treatment option for patients who are not candidates for surgical resection.

Primary renal echinococcosis with gross hydatiduria

Renal echinococcosis is a rare disease. It is usually asymptomatic but may present with pain, lump or in rare cases hydatiduria. Diagnosis is mainly by imaging but serology is usually false negative. We present a patient of renal echinococcosis who presented with passing of grape skin like structures in urine and was diagnosed to be a case of renal echinococcosis on the basis of positive serology, ultrasonographic and CT findings. The patient underwent a nephroureterectomy and was given albendazole preoperatively and postoperatively.

An undiagnosed giant right renal hydatid cyst treated laparoscopically: Case report and review of literature

Hydatid disease caused by the tape worm Echinococcus granulosus is a rare occurrence in the urinary system in general. We are hereby presenting a case of a gentleman in his fourth decade with a giant right renal hydatid cyst. The clinical manifestations, radiological features, and serology were all not suggestive of hydatid disease; however, typical Echinococcus scolices were detected histologically following cyst aspiration. The giant cyst was successfully treated laparoscopically.

Primary Renal Echinococcosis

Echinococcosis is a parasitic infection caused by the larval stage of a cestode Echinococcus granulosus and is endemic in sheep farming regions of developing countries. It manifests as hydatid cyst and most commonly is found in liver followed by lungs. Renal hydatid cyst is rare and amounts for 2% of all cases. There are no specific clinical manifestations, and hence diagnosis of renal hydatid disease is missed out easily without imaging. We report a case of 50-year-old female who had 6 months history of lower abdominal pain with hematuria, found to have right renal hydatid cyst on imaging which was treated with right nephrectomy with pre- and post-operative albendazole treatment.

Communicating (Open) Renal Hydatid Cyst Managed Successfully with Renal Sparing Approach

Renal hydatid disease accounts for 2% of all cases of hydatid cysts. With the majority of isolated renal hydatid disease patients being asymptomatic, hydatid cysts grow slowly for several years. They may be associated with pressure symptoms or flank pain, depending on their size and location. Hydatiduria occurs in less than one-fifth of the patients. In the absence of hydatiduria, diagnosis is usually radiological. Surgery is the mainstay of treatment which is usually renal sparing surgery as most cysts are non-communicating. In cases of cyst communicating with the collecting system, nephrectomy remains the mainstay of treatment. We report a case of hydatiduria due to a communicating hydatid cyst diagnosed on CT urography, where a renal sparing approach was followed and the patient was managed with cystopericystectomy, closure of Pelvicalyceal System (PCS) and double J (DJ) stenting with an excellent result.

Macroscopic Hydatiduria: An Uncommon Pathognomonic Presentation of Renal Hydatid Disease

Isolated renal hydatid disease is a rare endemic infestation caused by larval form of Echinococcus granulosus. Hydatiduria is an uncommon presentation of renal hydatid disease. In 2012 a 34-year-old female referred to Razi Hospital, Rasht, Iran with complaints of right flank pain and grape-like material in urine. Diagnosis was made by ultrasonography and CT scan. The patient was treated surgically with nephrectomy in combination with perioperative chemotherapy with albendazol.

Molecular genotyping of Echinococcus granulosus using formalin-fixed paraffin-embedded preparations from human isolates in unusual tissue sites

Cystic echinococcosis (CE) caused by Echinococcus granulosus remains a serious problem worldwide for issues relating to public health and the economy. The most predominantly affected sites are the liver and the lungs, but other organs such as the heart, the spleen and the peritoneum can also be infected. Access to cysts from uncommon sites has limited genomic and molecular investigations. In the present study, genotypes of E. granulosus sensu lato were identified from formalin-fixed paraffin-embedded tissues (FF-PETs) implicated in human CE. Tissue samples were obtained from 57 patients with histologically confirmed CE. DNA samples were analysed using Egss 1 polymerase chain reaction (PCR) specific to the mitochondrial 12S rRNA gene of E. granulosus sensu stricto. All cysts were typed as E. granulosus sensu stricto with up to 35% of the liver and 16.6% of lungs being the most frequently infected, and up to 48.4% of samples being from rare sites. No correlation was found between cyst site and either the gender or the age of patients. This study demonstrates the possibility of exploiting atypical cysts using FF-PET samples and highlights the predominance of E. granulosus sensu stricto species in the Tunisian population, even in unusual infection sites.