Multidisciplinary imaging of liver hydatidosis

Preoperative predictive factors of cystobiliary fistulas in liver hydatid cysts: results of a monocentric study

INTRODUCTION

The evolution of hepatic hydatid cyst can be enameled with complications, mainly biliary fistula, which can be both symptomatic or occult. The aim of this study is to identify the predictive factors of occult cysto-biliary communication.

MATERIAL AND METHODS

This is a retrospective study of patients operated-on for uncomplicated hepatic hydatid cyst in Farhat Hached Hospital of Sousse over a period of 10 years.

RESULTS

Two hundred twenty patients were operated-on for uncomplicated hydatid cyst. In univariate analysis, alkaline-phosphatase, gamma-glutamyl-transferase, alanine-transferase elevated levels and multiple type were factors associated with occult fistula, but gamma-glutamyl-transferase level was the only predictor in multivariate analysis.

CONCLUSION

These predictive factors could contribute to determine preoperative probability of occult fistula, thus indicating additional intraoperative procedures to ensure its identification.

Advances in Novel Diagnostic Techniques for Alveolar Echinococcosis

Alveolar echinococcosis (AE), caused by the larval stage of the tapeworm Echinococcus multilocularis, is a serious parasitic disease that presents significant health risks and challenges for both patients and healthcare systems. Accurate and timely diagnosis is essential for effective management and improved patient outcomes. This review summarizes the latest diagnostic methods for AE, focusing on serological tests and imaging techniques such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). Each imaging modality has its strengths and limitations in detecting and characterizing AE lesions, such as their location, size, and invasiveness. US is often the first-line method due to its non-invasiveness and cost-effectiveness, but it may have limitations in assessing complex lesions. CT provides detailed anatomical information and is particularly useful for assessing bone involvement and calcification. MRI, with its excellent soft tissue contrast, is superior for delineating the extent of AE lesions and their relationship to adjacent structures. PET/CT combines functional and morphological imaging to provide insights into the metabolic activity of lesions, which is valuable for monitoring treatment response and detecting recurrence. Overall, this review emphasizes the importance of a multifaceted diagnostic approach that combines serological and imaging techniques for accurate and early AE diagnosis, which is crucial for effective management and improved patient outcomes.

Cystic echinococcosis of the liver

BACKGROUND

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm, which is transmitted by dogs and found on every continent, except Antarctica. This study aimed to review the life cycle, epidemiology, symptoms, diagnostic methods, and treatment of E granulosus infection of the liver.

METHODS

A comprehensive review was conducted using MEDLINE/PubMed, Google Scholar, Cochrane Library, and the Web of Science, which were accessed between 1990 and 2024. The main search focused on "CE of the liver." The following terms were used: cystic echinococcosis, hydatidosis, E granulosus, echinococcus life cycle, liver cyst, albendazole, liver resection, pericystectomy, cystobiliary fistula, and percutaneous aspiration injection and reaspiration (PAIR).

RESULTS

CE should be considered in the differential diagnosis of hepatic cysts, especially among individuals with risk factors, such as those who have traveled to or immigrated from areas with a high prevalence. Echinococcus species require 2 hosts to complete their life cycle, with humans acting as intermediate hosts that become infected by ingesting eggs from contaminated environments, leading to cyst formation, typically in the liver or lungs. Symptoms are based on cyst size and location, such as abdominal pain, jaundice, respiratory distress, or neurologic deficits, and can lead to severe complications, such as cyst rupture, allergic reactions, sepsis, or secondary hydatidosis. Imaging plays a key role in evaluating cyst stage, size, location, and potential complications and in determining the appropriateness of a minimally invasive PAIR procedure. Although serum antibody tests typically have a low sensitivity, antigen assays or recombinant proteins may provide useful diagnostic information. For uncomplicated active cysts, the treatment options include chemotherapy alone or in combination with the PAIR technique.

CONCLUSION

Hepatic echinococcal cysts, which are relatively rare in North America, should be considered in the differential diagnosis of hepatic cysts, especially in individuals with risk factors.

Primary intermuscular hydatid cyst: A common disease at unusual location: Case report

Hydatid cyst is a parasitic infection caused by the Echinococcus granulosus and multilocularis species of tapeworm. An intermuscular hydatid cyst is an unusual location for hydatid cyst disease, even in endemic regions. Therefore, intermuscular hydatid cysts might be mistaken for other benign and malignant soft tissue tumors. Magnetic resonance imaging plays a crucial role in diagnosing intermuscular hydatid cysts by showing the typical imaging characteristics of the disease. Here, we report a case of an isolated intermuscular hydatid cyst disease in a 34-year-old man who presented with left posterior thigh swelling of 5 years duration. The diagnosis was established using magnetic resonance imaging, which showed large, well-encapsulated cystic lesions containing multiple daughter cysts of varying sizes, with some cysts containing detached floating membranes. Surgery was performed, together with preoperative and postoperative albendazole treatment.

Disseminated Abdominal Cystic Echinococcosis After Blunt Abdominal Trauma: A Case Report

Rupture of a hydatid cyst can lead to the development of a disseminated form of intra-abdominal cystic echinococcosis if not diagnosed and treated promptly. Anaphylactic shock is a definite indication of cyst rupture. The presented clinical case was a young athlete with a disseminated form of cystic echinococcosis, which was investigated in 2023 at the Syzganov National Scientific Center for Surgery of Kazakhstan. The disease developed gradually following a sports injury to the abdomen during sports training and was accompanied by blurred signs of anaphylactic shock. In the next 2 years, echinococcosis of the abdominal cavity was asymptomatic. The clinical manifestation of cystic echinococcosis developed gradually over the last 10-12 weeks, in the form of dull, painful abdominal pain, malaise, weakness, sweating, nausea, poor appetite, and weight loss. Subacute manifestations of the disease resembled those of acute appendicitis. A diagnostic laparotomy revealed an abundance of cystic formations in the abdominal cavity, necessitating a differential diagnosis between a disseminated form of abdominal tuberculosis with damage to the mesenteric lymph nodes. However, instrumental verification of the parasite, together with the morphological exclusion of the extrapulmonary form of tuberculosis, made it possible to establish a disseminated form of cystic echinococcosis. The patient underwent a cystectomy, was discharged in satisfactory condition, and was informed about the possibility of disease recurrence. In conclusion, in hyperendemic zones, it is recommended to carry out immunological testing for echinococcosis on all abdominal sports injuries, independent of the presence of anaphylactic shock symptoms.

Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI

Rim arterial phase hyperenhancement is an imaging feature commonly encountered on contrast-enhanced CT and MRI in focal liver lesions. Rim arterial phase hyperenhancement is a subtype of arterial phase hyperenhancement mainly present at the periphery of lesions on the arterial phase. It is caused by a relative arterialization of the periphery compared with the center of the lesion and needs to be differentiated from other patterns of peripheral enhancement, including the peripheral discontinuous nodular enhancement and the corona enhancement. Rim arterial phase hyperenhancement may be a typical or an atypical imaging presentation of many benign and malignant focal liver lesions, challenging the radiologists during imaging interpretation. Benign focal liver lesions that may show rim arterial phase hyperenhancement may have a vascular, infectious, or inflammatory origin. Malignant focal liver lesions displaying rim arterial phase hyperenhancement may have a vascular, hepatocellular, biliary, lymphoid, or secondary origin. The differences in imaging characteristics on contrast-enhanced CT may be subtle, and a multiparametric approach on MRI may be helpful to narrow the list of differentials. This article aims to review the broad spectrum of focal liver lesions that may show rim arterial phase hyperenhancement, using an approach based on the benign and malignant nature of lesions and their histologic origin. CRITICAL RELEVANCE STATEMENT: Rim arterial phase hyperenhancement may be an imaging feature encountered in benign and malignant focal liver lesions and the diagnostic algorithm approach provided in this educational review may guide toward the final diagnosis. KEY POINTS: Several focal liver lesions may demonstrate rim arterial phase hyperenhancement. Rim arterial phase hyperenhancement may occur in vascular, inflammatory, and neoplastic lesions. Rim arterial phase hyperenhancement may challenge radiologists during image interpretation.

Optimized Strategies for Managing Abdominal Hydatid Cysts and Their Complications

Hepatic hydatid cysts are an example of a zoonosis with global distribution, but with endemic characteristics in certain geographic areas. Known since ancient times, this parasitic infection predominantly affecting the liver and lungs remains a challenge today in terms of diagnosis and the pharmacological, radiological, endoscopic, or surgical therapy. This study analyzed the complications associated with different procedures for treating hydatid cysts in 76 patients admitted to the County Clinical Emergency Hospital of Sibiu. Complications occurred in 18 patients (23.7%), with no significant correlation to age, gender, or residency (urban or rural). Patients undergoing open surgery exhibited the highest complication rate (61.1%) compared to those treated with other procedures. The most frequent complication was biliary duct rupture, occurring in 22.7% of cases. Our findings indicate that the presence of complications significantly prolongs hospitalization time [t df (75) = 12.14, p < 0.001]. Based on these findings, we conclude that the surgical approach for hydatid cysts should be meticulously tailored to each patient's specific circumstances to reduce the risk of complications and improve clinical outcomes.

Complex cystic liver lesions: classification, diagnosis, and management

Cystic liver disease has been increasingly reported in the literature, with a prevalence as high as 15-18%. Hepatic cysts are usually discovered incidentally, while their characterization and classification rely on improved imaging modalities. Complex cystic liver lesions comprise a wide variety of novel, re-introduced, and re-classified clinical entities. This spectrum of disorders ranges from non-neoplastic conditions to benign and malignant tumors. Their clinicopathological features, prognostic factors, and oncogenic pathways are incompletely understood. Despite representing a heterogeneous group of disorders, they can have similar clinical and imaging characteristics. As a result, the diagnosis and management of complex liver cysts can become quite challenging. Furthermore, inappropriate diagnosis and management can lead to high morbidity and mortality. In this review, we aim to offer up-to-date insight into the diagnosis, classification, and management of the most common complex cystic liver lesions.

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.

Intra-biliary hydatid cyst rupture: A rare case report with superinfection

Key Clinical Message

Hydatid cysts, primarily found in the liver (70%), are caused by parasitic infections and can lead to severe complications such as cyst rupture. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.

Abstract

Hydatid cysts are a clinical pathology resulting from parasitic infections. They may occur in different organs of the body. However, these are mostly found in the liver (70%). This can cause significant complications including cyst rupture. Several case reports have described various hydatid cyst ruptures; however, only a few have reported an intra-biliary hydatid cyst rupture. A 24-year-old male patient presented with right upper quadrant pain, jaundice, dark urine, and pale stool. Imaging studies, including Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), revealed a beavertail liver, cystobiliary communication and intrahepatic biliary tree-ruptured hydatid cysts. The cyst was in the right liver lobe, which is the most common site for hydatid cysts. Surgical intervention involving laparoscopic de-roofing and cyst removal resulted in a smooth recovery without complications. Several case reports have described various hydatid cyst ruptures; however, only a few have reported originally placed intra-biliary hydatid cyst ruptures. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.

Percutaneous treatment of liver hydatid cysts: to PAIR or not to PAIR

PURPOSE OF REVIEW

The aim is to review recent literature for percutaneous treatment of liver hydatid cysts (cystic echinococcosis: CE) via different techniques such as PAIR (puncture, aspiration, injection, and reaspiration), standard catheterization, and modified catheterization technique (MoCaT).

RECENT FINDINGS

PAIR is an established technique and considered to be safe and effective for CE1 and CE3a as it is associated with lower morbidity, mortality, recurrence, and shorter hospital stay as compared with surgery. Standard catheterization is also dedicated for the treatment of CE1 and CE3a. PAIR should be preferred for treatment of liver CE1 and CE3a cysts, since PAIR is associated with lower major complication rates and shorter hospital stay. However, standard catheterization technique is indicated when cysto-biliary fistula develops or any technical difficulty arises during the PAIR. In these cases it is needed to switch PAIR to standard catheterization to complete the procedure.

SUMMARY

For CE1 and CE3a cysts, PAIR and standard catheterization are the choice for percutaneous treatments, while MoCaT is a treatment option for CE2 and CE3b cysts.

Management of liver hydatid cyst: A case report

Hydatid disease, if not properly managed, can lead to mortality. Open surgery is preferred and can be a curative approach for multiple and large liver hydatid cysts. Also, regular follow-up is required to detect recurrence.

Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience?

BACKGROUND

Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach.

AIM

To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study.

METHODS

Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008).

RESULTS

There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001).

CONCLUSION

Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.

An uncommon way of revelation of a primary diaphragmatic hydatid cyst: A case report

INTRODUCTION AND IMPORTANCE

Diaphragmatic hydatid cyst is a misdiagnosed condition. The challenge is to suspect this rare entity on nonspecific clinical features and to localize the cyst on imaging in order to determine the surgical approach. Surgery is the only curative treatment and confirmation is set on pathology examination.

CASE PRESENTATION

We present the case of a twenty-six-year-old patient, with no medical history, who complained of recurrent right thoracic pains rebel to opioids. All radiological items lead to suspect a diaphragmatic hydatid cyst. Surgery permitted a complete resection of the cyst and a total relief of the pains.

CLINICAL DISCUSSION

The diagnosis of diaphragmatic hydatid cyst is a real challenge. Several diagnoses can be evoked such as hydatid disease depending from the liver, cystic lymphangioma or neural intercostal benign tumor. The phrenic origin of the cyst can only be identified through surgery. However, it is very important to clearly characterize the lesion to well conduct surgical approach.

CONCLUSION

It is important for surgeons to suspect diaphragmatic hydatid cysts despite its rarity. CT-scan and MRI are helpful tools to localize the disease and to conduct the surgical procedure. Final diagnosis is only set on pathology examination after curative surgery.

The Neoplasms Mimicker: A Pictorial Review of Hydatid Disease

Hydatid cyst is a common name for the larval stage of a tapeworm species of the genus Echinococcus granulosus, which is transmitted from animals to humans via the fecal–oral route. Hydatid cysts predominantly affect the liver (75%), followed by the lung (15%), and they can affect many organs in the human body. Medical imaging modalities are the keystone for the diagnosis of hydatid cysts with high sensitivity and specificity. Ultrasound imaging with high resolution is the first choice for diagnosis, differential diagnosis, staging, establishing a role in interventional management, and follow-up, and it can differentiate Type I hydatid cysts from simple liver cysts. Unenhanced computed tomography (CT) is indicated where or when an ultrasound is unsatisfactory, such as with chest or brain hydatid cysts, when detecting calcification, and in obese patients. Magnetic resonance imaging (MRI) is superior for demonstrating cyst wall defects, biliary communication, neural involvement, and differentiating hydatid cysts from simple cysts using diffusion-weighted imaging (DWI) sequences. According to the phase of growth, hydatid cysts occur in different sizes and shapes, which may mimic benign or malignant neoplasms and may create diagnostic challenges in some cases. Hydatid cysts can mimic simple cysts, choledochal cysts, Caroli’s disease, or mesenchymal hamartomas of the liver. They can mimic lung cystic lesions, mycetoma, blood clots, Rasmussen aneurysms, and even lung carcinomas. Differential diagnosis can be difficult for arachnoid cysts, porencephalic cysts, pyogenic abscesses, and even cystic tumors of the brain, and can create diagnostic dilemmas in the musculoskeletal system.

Donor Simvastatin Treatment Is Safe and Might Improve Outcomes After Liver Transplantation: A Randomized Clinical Trial

BACKGROUND

The current curative approaches for ischemia/reperfusion injury on liver transplantation are still under debate for their safety and efficacy in patients with end-stage liver disease. We present the SIMVA statin donor treatment before Liver Transplants study.

METHODS

SIMVA statin donor treatment before Liver Transplants is a monocentric, double-blind, randomized, prospective tial aiming to compare the safety and efficacy of preoperative brain-dead donors' treatment with the intragastric administration of 80 mg of simvastatin on liver transplant recipient outcomes in a real-life setting. Primary aim was incidence of patient and graft survival at 90 and 180 d posttransplant; secondary end-points were severe complications.

RESULTS

The trial enrolled 58 adult patients (18-65 y old). The minimum follow-up was 6 mo. No patient or graft was lost at 90 or 180 d in the experimental group (n = 28), whereas patient/graft survival were 93.1% ( P = 0.016) and 89.66% ( P = 0.080) at 90 d and 86.21% ( P = 0.041) and 86.2% ( P = 0.041) at 180 d in the control group (n = 29). The percentage of patients with severe complications (Clavien-Dindo ≥IIIb) was higher in the control group, 55.2% versus 25.0% in the experimental group ( P = 0.0307). The only significant difference in liver tests was a significantly higher gamma-glutamyl transferase and alkaline phosphatase at 15 d ( P = 0.017), ( P = 0.015) in the simvastatin group.

CONCLUSIONS

Donor simvastatin treatment is safe, and may significantly improve early graft and patient survival after liver transplantation, although further research is mandatory.

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.

Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE)

OBJECTIVES

Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association.

MATERIAL AND METHODS

This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach.

RESULTS

Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed.

CONCLUSION

The expert panel made recommendations for every topic.

Recurrent graft failure secondary to portal vein steal syndrome: a case report with an unusual indication for a third liver transplant

Background

Portal vein shunt is common in chronic hepatic diseases and after a liver transplant. Ensuring a satisfactory portal flow is essential to support a rapid liver recovery, of paramount importance to meet the recipient’s metabolic needs.

Case presentation

We report the case of a 32-year-old female undergoing a third liver transplant due to recurrence of graft failure secondary to portosystemic shunting. The patient, affected with biliary atresia, was first transplanted in 2009 with a right split liver graft. The clinical course was complicated by biliary stenosis of the Roux-en-Y anastomosis and multiple episodes of acute rejection treated with steroid boluses, plastic dilation of the biliary anastomosis, and biliary catheter placement. Unfortunately, in 2017 a liver biopsy showed an autoimmunity with histological evidence of ANA 1:80 (granular and nucleolar pattern). This was a contributing factor of liver function impairment, leading to the need to perform a second liver transplant, complicated by an acute rejection, with only a partial response to steroid therapy. Due to the further worsening of the liver function (MELD: 40, Child–Pugh: C11), the patient was relisted for a liver transplant. After five days, she received her third liver transplant, with an entire graft of an AB0 identical group. Intraoperative exploration revealed multiple collaterals and large splenocaval shunts, with a significant alteration of the portal flow and hypertension, isolated and closed with a vascular stapler to restore the graft's regular portal vein flow.

Conclusions

In patients listed for a liver transplant, portal steal syndrome should be identified prior to the transplant. Our recommendation is to consider intraoperative or perioperative closure of the portal collateral varices.

[Liver echinococcosis in a non-endemic region]

OBJECTIVE

To study clinical manifestations and difficulties in diagnosis of liver echinococcosis in a non-endemic region and to assess the long-term results of surgical treatment and quality of life.

MATERIAL AND METHODS

The study included 36 residents of a non-endemic region with liver echinococcosis operated on in the Perm Regional Clinical Hospital over the past 15 years. IgG antibodies to echinococcal antigens were determined using enzyme immunoassay. Topical diagnosis was performed using ultrasound and contrast-enhanced computed tomography. We analyzed various difficulties of preoperative diagnosis. Long-term postoperative outcomes and quality of life were studied using the SF-36 questionnaire.

RESULTS

In the non-endemic Perm Region, 36% of patients with liver echinococcosis had complicated forms of disease. Sensitivity of detection of antibodies was 77%, ultrasound - 86.1%, CT - 91.7. Echinococcectomy was performed in 13.9% of cases, pericystecomy - 41.7%, liver resection - 30.6%, minimally invasive interventions - in 13.9% of patients. Long-term recurrence of liver echinococcosis (11.1%) developed after laparoscopic echinococcectomy (n=2) and open surgery for multiple liver echinococcosis (n=2). Median score of physical health in long-term period was slightly higher than mental health (67.51 and 62.75 points, respectively). Physical activity had a weak negative correlation with age (p=0.001, r= -0.251). Concomitant diseases significantly impaired vital activity (p=0.001, r= -0.332), role and emotional functioning (p=0.002, r= -0.494; p=0.003, r= -0.415).

CONCLUSION

In a non-endemic region, final diagnosis was established only during therapeutic measures in 8.33% of cases. Surgical treatment ensured favorable quality of life in long-term period.

Liver Transplantation for Unresectable Intrahepatic Cholangiocarcinoma: The Role of Sequencing Genetic Profiling

Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive primary liver tumor, characterized by a range of different clinical manifestations and by increasing incidence and mortality rates even after curative treatment with radical resection. In recent years, growing attention has been devoted to this disease and some evidence supports liver transplantation (LT) as an appropriate treatment for intrahepatic cholangiocarcinoma; evolving work has also provided a framework for better understanding the genetic basis of this cancer. The aim of this study was to provide a clinical description of our series of patients complemented with Next-Generation Sequencing genomic profiling. From 1999 to 2021, 12 patients who underwent LT with either iCCA or a combined hepatocellular and cholangiocellular carcinoma (HCC-iCCA) were included in this study. Mutations were observed in gene activating signaling pathways known to be involved with iCCA tumorigenesis (KRAS/MAPK, P53, PI3K-Akt/mTOR, cAMP, WNT, epigenetic regulation and chromatin remodeling). Among several others, a strong association was observed between the Notch pathway and tumor size (point-biserial rhopb = 0.93). Our results are suggestive of the benefit potentially derived from molecular analysis to improve our diagnostic capabilities and to devise new treatment protocols, and eventually ameliorate long-term survival of patients affected by iCCA or HCC-iCCA.

The use of normothermic machine perfusion to rescue liver allografts from expanded criteria donors

The use of expanded criteria donors is one of the strategies used to overcome the gap between the demand for organs and the number of donors. Physicians debate the extent to which marginal grafts can be used. In recent years, normothermic machine perfusion (NMP) has been used to test liver viability before transplantation. Grafts underwent NMP whenever histological steatosis was > 40% or there were at least three Eurotransplant criteria for expanded criteria donor (ECD). We used NMP to test 19 grafts, 3 from donation after type 3 controlled cardiac death (DCD), and 16 from donation after brain death (DBD). Only two grafts from DBD were not transplanted, because perfusion proved they were not suitable (total of 17 transplanted grafts of 19 tested grafts). Kaplan-Meier survival estimates at 30, 90, 180, and 1 year after transplant were all 94% (95% CI 84-100%); estimated 3-years survival was 82% (95% CI 62-100%). Overall survival rates did not differ from those of patients transplanted with non-perfused grafts from an ECD. In our experience, the use of very marginal grafts preventively tested by NMP does not negatively influence the patient's outcome, and increases the number of transplants in low donation areas.

Imaging of calcified hepatic lesions: spectrum of diseases

Hepatic calcifications have been increasingly identified over the past decade due to the widespread use of high-resolution Computed Tomography (CT) imaging. Calcifications can be seen in a vast spectrum of common and uncommon diseases, from benign to malignant, including cystic lesions, solid neoplastic masses, and inflammatory focal lesions. The purpose of this paper is to present an updated review of CT imaging findings of a wide range of calcified hepatic focal lesions, which can help radiologists to narrow the differential diagnosis.

Computed tomography and magnetic resonance imaging of hydatid disease: A pictorial review of uncommon imaging presentations

Hydatid disease (HD), also known as echinococcal disease or echinococcosis, is a worldwide zoonosis with a wide geographic distribution. It can be found in almost all parts of the body and usually remains silent for a long period of time. Clinical history can be varied based on the location, size, host immune response, and complications.

The most common imaging modalities used for diagnosis and further evaluations of HD are ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Although conventional radiography may be the first used tool, rarely can lead to a definite judgment. Clinical indications and cyst location may alter the choice of imaging. MRI and CT would be useful when the involved area is inaccessible for ultrasound or surgical treatment is required. CT is particularly valuable for osseous organ involvements and the presence of calcifications in the cyst and also demonstrates the size, number, and local complications. MRI can differentiate HD from neoplasms in cases with an unusual appearance on imaging. Moreover, it is preferable in biliary or neural involvements. Besides, more detailed images of MRI and CT could help to resolve the diagnostic uncertainty.

Imaging is the main stem for HD diagnosis. Brain, orbit, muscle, bone, and vascular structures are less commonly involved areas. Familiarity with typical clinical presentation, CT scan and MR imaging findings of HD in this sites facilitate the radiologic diagnosis and guiding appropriate treatment.

Endocystectomy as a conservative surgical treatment for hepatic cystic echinococcosis: A systematic review with single-arm meta-analysis

BACKGROUND

In patients with hepatic cystic echinococcosis (CE), treatment effectiveness, outcomes, complications, and recurrence rate are controversial. Endocystectomy is a conservative surgical approach that adequately removes cyst contents without loss of parenchyma. This conservative procedure has been modified in several ways to prevent complications and to improve surgical outcomes. This systematic review aimed to evaluate the intraoperative and postoperative complications of endocysectomy for hepatic CE as well as the hepatic CE recurrence rate following endocystectomy.

METHODS

A systematic search was made for all studies reporting endocystectomy to manage hepatic CE in PubMed, Web of Science, and Cochrane CENTRAL databases. Study quality was assessed using the methodological index for non-randomized studies (MINORS) criteria and the Cochrane revised tool to assess risk of bias in randomized trials (RoB2). The random-effects model was used for meta-analysis and the arscine-transformed proportions were used to determine complication-, mortality-, and recurrence rates. This study is registered with PROSPERO (number CRD42020181732).

RESULTS

Of 3,930 retrieved articles, 54 studies reporting on 4,058 patients were included. Among studies reporting preoperative anthelmintic treatment (31 studies), albendazole was administered in all of them. Complications were reported in 19.4% (95% CI: 15.9-23.2; I2 = 84%; p-value <0.001) of the patients; biliary leakage (10.1%; 95% CI: 7.5-13.1; I2 = 81%; p-value <0.001) and wound infection (6.6%; 95% CI: 4.6-9; I2 = 27%; p-value = 0.17) were the most common complications. The post-endocystectomy mortality rate was 1.2% (95% CI: 0.8-1.8; I2 = 21%; p-value = 0.15) and the recurrence rate was 4.8% (95% CI: 3.1-6.8; I2 = 87%; p-value <0.001). Thirty-nine studies (88.7%) had a mean follow-up of more than one year after endocystectomy, and only 14 studies (31.8%) had a follow-up of more than five years.

CONCLUSION

Endocystectomy is a conservative and feasible surgical approach. Despite previous disencouraging experiences, our results suggest that endocystectomy is associated with low mortality and recurrence.

Typical imaging finding of hepatic infections: a pictorial essay

Hepatic infections are frequent in clinical practice. Although epidemiological, clinical and laboratory data may suggest hepatic infection in certain cases, imaging is nearly always necessary to confirm the diagnosis, assess disease extension and its complications, evaluate the response to treatment, and sometimes to make differential diagnoses such as malignancies. Ultrasound (US) is usually the first-line investigation, while computed tomography (CT) and magnetic resonance imaging (MRI) provide better characterization and a more precise assessment of local extension, especially biliary and vascular. The purpose of this article is to describe the typical features and main complications of common hepatic infections. Familiarity with the radiological features of this entity can help suggest the correct diagnosis and the need for further studies as well as determine appropriate and timely treatment.

Clinical and Molecular-Based Approach in the Evaluation of Hepatocellular Carcinoma Recurrence after Radical Liver Resection

BACKGROUND

Hepatic resection remains the treatment of choice for patients with early-stage HCC with preserved liver function. Unfortunately, however, the majority of patients develop tumor recurrence. While several clinical factors were found to be associated with tumor recurrence, HCC pathogenesis is a complex process of accumulation of somatic genomic alterations, which leads to a huge molecular heterogeneity that has not been completely understood. The aim of this study is to complement potentially predictive clinical and pathological factors with next-generation sequencing genomic profiling and loss of heterozygosity analysis.

METHODS

124 HCC patients, who underwent a primary hepatic resection from January 2016 to December 2019, were recruited for this study. Next-generation sequencing (NGS) analysis and allelic imbalance assessment in a case-control subgroup analysis were performed. A time-to-recurrence analysis was performed as well by means of Kaplan-Meier estimators.

RESULTS

Cumulative number of HCC recurrences were 26 (21%) and 32 (26%), respectively, one and two years after surgery. Kaplan-Meier estimates for the probability of recurrence amounted to 37% (95% C.I.: 24-47) and to 51% (95% C.I.: 35-62), after one and two years, respectively. Multivariable analysis identified as independent predictors of HCC recurrence: hepatitis C virus (HCV) infection (HR: 1.96, 95%C.I.: 0.91-4.24, p = 0.085), serum bilirubin levels (HR: 5.32, 95%C.I.: 2.07-13.69, p = 0.001), number of nodules (HR: 1.63, 95%C.I.: 1.12-2.38, p = 0.011) and size of the larger nodule (HR: 1.11, 95%C.I.: 1.03-1.18, p = 0.004). Time-to-recurrence analysis showed that loss of heterozygosity in the PTEN loci (involved in the PI3K/AKT/mTOR signaling pathway) was significantly associated with a lower risk of HCC recurrence (HR: 0.35, 95%C.I.: 0.13-0.93, p = 0.036).

CONCLUSIONS

multiple alterations of cancer genes are associated with HCC progression. In particular, the evidence of a specific AI mutation presented in 20 patients seemed to have a protective effect on the risk of HCC recurrence.

Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation

Background

One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed.

Case presentation and conclusion

We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient affected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural effusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well. The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts.

Case 275: Multiple Hepatic Hydatid Cysts

HistoryA 61-year-old woman presented to the cardiology service with sinus tachycardia. As part of her work-up, she underwent routine echocardiography that showed a normal heart but incidentally revealed multiple lesions in the liver. An outpatient CT scan was performed to characterize the liver lesions. The patient had emigrated to Canada from the Middle East several years earlier and had no medical history of note; in particular, there was no history of cancer or predisposing factors for chronic liver disease. The patient's clinical examination findings; laboratory test results, including complete blood count; and liver function test results were normal.

Parasitic diseases as a cause of acute abdominal pain: imaging findings

Acute abdominal pain can be seen in cases with parasitic diseases delivered to emergency departments. The diagnosis of the parasitic disease can be delayed because of the similar clinical signs encountered in other frequently seen causes of acute abdomen. Nevertheless, the features detected in imaging scans can be helpful in the diagnosis. The present study aims to raise awareness about abdominal parasitosis in emergency conditions and also to underline the association between imaging findings and the life cycle of parasites with illustrative cases.

Uncommon musculoskeletal femoral hydatid cyst disturbs a female for a year: Case report

“Hydatid cyst” which also known as cystic Echinococcosis is a parasitic infestation caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most sites to occur. Incidence in muscles is exceptionally rare.

We report a case of a 36-year-old female presented with an uncomfortable mass in the upper medial of her right thigh without any presence of other symptoms. She lived in a rural area in Manbij, which is an endemic area of hydatid cysts in Syria. She was a shepherdess; therefore she had direct contact with sheep and dogs. Ultrasound examination showed a cyst located between adductor longus muscle and gracilis muscle closed to the deep femoral artery. The patient was treated with pharmaceutical therapy for a week before cystectomy, which was done under general anesthesia. The cyst was dissected between the fibers of adductor longus muscle from the lateral side and fibers of the gracilis muscle from the medial side. The cyst with all its layers was resected.

Musculoskeletal Echinococcosis is a rare disease, because of intramuscular growth of cysts is restricted by muscle's contractility, the muscles are undesirable habitat for Echinococcus granulosus and because of the hepatic barrier role. Many cysts are revealed by complications such as nerve compressions, infections simulating an acute abscess or a malignant tumor.

Hydatid cyst present as mass of soft tissue, particularly in endemic areas, as a result of contaminated water. MRI considered the best technique in the diagnosis.

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Incidence of Hydatid cyst in muscles is exceptionally rare.

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MRI considered the best technique in the diagnosis.

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Confirming the final preoperative diagnosis of muscle hydatid cysts is important.

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Hydatid cyst should consider as a differential diagnosis for masses of soft tissue.

Calcified Splenic Lesions: Pattern Recognition Approach on CT With Pathologic Correlation

OBJECTIVE. Incidental splenic lesions, often found on CT images of the abdomen, may often be ignored or mischaracterized. Calcified splenic lesions are often presumed to be granulomas; however, understanding the broader differential diagnostic considerations can be useful. CONCLUSION. Determining the cause of splenic lesions is essential to guide appropriate management; the pattern of calcification together with other imaging and clinical findings can aid with differentiation.

Pleuritic chest pain in a young asylum seeker

A 17-year-old asylum seeker from Afghanistan presented to the emergency department with chest pain. He had travelled to the UK after residing in multiple European cities. He presented with a 1-week history of right-sided pleuritic chest pain. There was no evidence of a productive cough or recent viral illness and he had no history of injury to the chest. In addition to his chest pain, he had been suffering from persistent right upper quadrant discomfort for approximately 3 years. There was no nausea or vomiting and he denied any bowel or urinary symptoms. He had experienced episodes of fever and loss of appetite but no change in weight. His past medical background consisted of black water fever, as a consequence of malaria, and a previous gunshot wound, which had now healed. He took no regular medications and all of his clinical observations were stable at the time of presentation.

It is important to note that a negative serological test result does not exclude a diagnosis of cystic Echinococcus, particularly in cases of extra hepatic diseasehttp://bit.ly/2JRAk6H

Not just minor resections: robotic approach for cystic echinococcosis of the liver

INTRODUCTION

Human echinococcosis is among the 17 neglected tropical diseases recognized by the World Health Organization. It is responsible for over $3 billion of health costs every year being endemic in large areas worldwide, and liver is affected in 70% of the cases. Surgery associated to medical treatment is the gold standard and robotic approach may be a valuable tool to achieve safe, parenchyma sparing resections.

METHODS

We retrospectively analyzed the outcomes of patients that underwent robotic radical surgical treatment for hydatid liver disease, from prospectively maintained databases of three Italian centers.

RESULTS

15 patients were included in this study, median age 51 years (24-76). 1 right hepatectomy, 2 left lateral sectionectomies, 5 segmentectomies (including 1 caudatectomy), 3 wedge resections and 5 cyst-pericystectomies were performed. Median estimated blood loss was of 100 ml (50-550 ml), and median operative time including docking was 210 min (95-590 min), with no need for conversion to open. Median hospital stay was 4 days, with only one readmission for fever. Only one patient experienced recurrence in a different liver segment.

CONCLUSIONS

In our experience, robotic approach for cystic echinococcosis of the liver proved to be a safe and effective strategy also in the so-called "difficult segments", with short post-operative stay and quick return to daily activities, along with the absence of surgical site recurrences. To the best of our knowledge, this is the largest report of robotic approach to hydatid liver disease.

Adductor magnus muscle primary hydatid cyst rare unusual site: A case report

INTRODUCTION

The preferred localization of human echinococcosis is the liver and lungs, which account for 85% of cases. Primary musculoskeletal hydatidosis are seldom reported in literature and their incidence is unknown. Primary solitary intramuscular hydatid disease is rare, even in countries in which echinococcosis is endemic and accounts for 1% of all human echinococcosis sites.

CASE PRESENTATION

37-year-old male farmer presented with primary hydatid cyst of the upper medial side of right thigh (Inside adductor magnus muscle) who was managed successfully by preoperative and postoperative dual treatment of albendazole together with surgery.

DISCUSSION

This site of localization has not been reported previously. It is essential to establish definitive preoperative diagnosis of skeletal muscle hydatid cysts. This contraindicates certain treatment options like marginal excision or incisional biopsy due to the likelihood of dissemination and anaphylactic shock on spillage. Pericystectomy remains treatment of choice in musculoskeletal hydatid cysts.

CONCLUSION

Hydatid disease should be included in the differential diagnosis of muscular masses, regardless of its location, especially in endemic areas.

Intra-Abdominal Hydatid Cyst: Sociodemographics, Clinical Profiles, and Outcomes of Patients Operated on at a Tertiary Hospital in Addis Ababa, Ethiopia

Background

Hydatid cyst is caused by the tapeworm Echinococcus granulosus. The abdomen, specifically the liver, is the most common site affected.

Objective

Determine the presentation patterns, types of surgical management, and outcomes of patients operated for intra-abdominal hydatid cyst (IAHC).

Methodology

A retrospective descriptive study of patients admitted and operated for IAHC from September 1, 2011, to August 31, 2015.

Results

Forty-two patients whose age ranged from 10 to 65 (mean of 37 years) were operated on. Females comprised 27 (64.3%) of the patients. The commonest presenting complaint was abdominal pain (41, 97.6%). Abdominal mass was documented in 23 (54.7%) cases. Abdominal ultrasound (AUS) and CT were the main imaging studies done on 38 (90.5%) and 24 (57.1%) patients, respectively. Cysts measuring more than 10 cm in diameter were the most common finding in both studies. Liver was the primary site involved, 30 (71.4%) cases, the right lobe being the main side, 73%. Thirty-eight (90.5%) patients underwent deroofing, evacuation, marsupialization, and omentoplasty (DEMO). There was no perioperative death, but 4 (9.5%) of the patients had post-op complications.

Conclusion

Abdominal pain was the most common presenting complaint. AUS and CT remain the preferred imaging. DEMO was the most common surgery.

Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization

Cystic echinococcosis (CE), also known as "hydatid disease" (HD), is a zoonotic infection caused by the larval stage of Echinococcus granulosus, which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal venous blood, the embryos released by the eggs of the tapeworms can reach every organ, especially the liver, turning into a hydatid cyst. Usually asymptomatic, the cysts can be incidentally detected through radiological examinations performed for other reasons. We show an unusual case of superinfection of a hydatid cyst with typical radiological features of inactivity (WHO-type CE5) with an even rarer skin fistulization passing through a subcutaneous-abdominal abscess involving the right iliac muscle.

Recurrent multiple-organ involvement of disseminated alveolar echinococcosis in 3 patients: Case report

RATIONALE

Alveolar echinococcosis (AE) is a rare but highly malignant form of echinococcosis caused by Echinococcus multilocularis. There have been very few reports on multiple-organ AE, especially AE in bones. Here we report 3 rare cases of disseminated multiple-organ AE from western China and its neighboring areas.

PATIENT CONCERNS

Patient 1 had back and left hip pain, headache, and weakness in left lower limb, often with minor epilepsy and fluctuation of blood pressure. Lower limbs Babinski sign was positive and muscular tension was above normal range. The second patient had pain in lower limbs and chest discomfort without fever, cough, sputum, chest tightness, or hemoptysis. Patient 3 had masses and pain in the back side of his right shoulder.

DIAGNOSES

The patients had been treated for AE multiple times and were positive for serum hydatid antigens. They were diagnosed as multiorgan AE involving liver, spinal cord, and many other organs.

INTERVENTIONS

The patients had undergone surgeries to decompress the spinal cord, remove lesions from tissues as required, and were put on albendazole for at least 2 years.

OUTCOMES

The patients responded well and AE recurrence has not occurred.

LESSONS

All 3 cases experienced multiple recurrences of AE due to missed diagnosis, misdiagnosis, or inappropriate treatment, which resulted in metastatic multiorgan AE. These cases demonstrated the need for more policy attention to battle AE endemic in western China.

Musculoskeletal Echinococcus infection as a rare first presentation of hydatid disease: case report

Background

Hydatid disease (HD) is a cosmopolitan parasitosis caused by Echinococcus granulosus that can potentially affect any part of the human body. Liver and lungs are the most frequent localizations. Primary musculoskeletal hydatidosis are seldom reported in literature and their incidence is unknown.

Case presentation

We deem interesting to report a case of a primary hydatid cyst in a 25-year-old patient who presented with a painful swelling of the right elbow. Meticulous examination and preoperative imaging did not reveal other localizations. Patient was admitted for surgery where total excision of cyst was done without intraoperative spillage and a cutaneous skin flap was subsequently required to make up for soft tissue loss.

Conclusion

Primary hydatid cysts are sometimes difficult to diagnose preoperatively. It should be considered in the differential diagnosis of subcutaneous cystic lesions in regions where hydatid cysts are endemic. Currently, surgical excision is deemed first choice treatment for solitary cysts and antihelminthic treatment should be initiated preoperatively in the case of risk of rupture or in the event of complications.

The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease

The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.

Hepatic hydatid disease complications: review of imaging findings and clinical implications

Hydatid disease is a zoonotic parasitic disease. The liver is the most commonly affected organ, and hepatic hydatid disease complications are not uncommon. Hydatid cyst superinfection, intrabiliary rupture, and direct rupture into the thoracic or abdominal cavities are the frequently encountered complications. Other exceedingly rare complications include rupture of the cyst into hollow viscera, abdominal wall invasion, and hepatic vasculature-related complications such as portal vein thrombosis and Budd-Chiari syndrome. These complications have variable clinical presentations and imaging findings and require different medical and surgical managements. We aim to provide a spectrum of imaging findings of different common and uncommon complications of hepatic hydatid disease with emphasis on their clinical implications.

Presumptive case of sparganosis manifesting as a hepatic mass: A case report and literature review

A 60-year-old man was admitted due to rectosigmoid colon cancer, and a hepatic mass was incidentally found during the staging work-up. The mass appeared cystic with a thick wall and contained multiple bizarre cord-like structures on ultrasound, computed tomography and magnetic resonance imaging. The differential diagnoses included organizing abscess/hematoma, foreign body granuloma and parasite infestation. Serologic study revealed anti-sparganum antibodies. Over 4-year follow-up, the patient did not complain of symptoms, and no changes in the characteristics of the liver mass were observed. Hepatic sparganosis is rare; only two cases have been clinically reported, and no detailed radiologic description was available until now. This case report presents a detailed radiologic description of a hepatic mass that could most likely represent hepatic sparganosis.

Hepatic Echinococcal Cysts: A Review

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5-10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.

Radiological manifestations of hydatid disease and its complications

Hydatid disease (HD) is endemic in many parts of the world. HD can affect virtually any organ system in body and should be kept as differential diagnosis of cystic lesion. HD is mostly asymptomatic; however, it demonstrates a variety of characteristic imaging findings depending on the site of involvement, stage of growth, mass effect, complications, or hematogenous spread, which helps in diagnosis. Radiography, ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used imaging modalities. Radiography is helpful in chest and for demonstrating calcification. USG demonstrates characteristic findings such as cystic nature, daughter vesicles, membranes, septa, and hydatid sand. CT and MRI are modalities of choice for number, size, anatomic location, identification of local complications, and systemic spread. CT is, especially helpful for osseous involvement, and MRI is better for biliary and neurological involvement. Knowledge of these imaging findings helps in early diagnosis and timely initiation of appropriate therapy.