Giant Calcified Hepatic Hydatid Cyst: A Case Report

Hydatid disease is a zoonotic disease caused by the parasite Echinococcus granulosus. It is an endemic disease in many parts of the world. Although humans are incidental hosts of the parasite, the disease sometimes results in fatal consequences. The liver and lungs are the most common sites of infection in humans. We report the case of a 45-year-old female who presented with complaints of right hypochondriac pain, fever, and cough, initially suspected as a case of liver abscess but later diagnosed as a giant calcified hydatid cyst of the liver. Imaging and immunoglobulin G for Echinococcus granulosus helped confirm our diagnosis. Based on her symptoms, the patient was treated symptomatically with analgesics, paracetamol, and an antitussive for pain, fever, and cough, respectively. In terms of definitive care, she was treated with oral albendazole and referred to her home district for necessary surgical intervention.

Don't miss it: Extremity-located cyst hydatid may mimic soft tissue tumors

OBJECTIVES

In this study, we present our experience in patients with hydatid cysts located intramuscularly.

PATIENTS AND METHODS

Between May 2018 and May 2023, a total of 11 patients (3 males, 8 females; mean age: 29.1±13.6 years; range, 8 to 56 years) with intramuscular hydatid cysts were retrospectively analyzed. Demographic data, laboratory values, serological test results, location and size of the cyst, radiological imaging findings, and complications were recorded.

RESULTS

The mean follow-up was 44.3±17.3 (range, 5 to 60) months. The mean mass size at the time of admission was 5.4±3.3 (range, 2 to 14) cm. Serologic tests were positive in the majority of cases (72.7%). Eosinophilia was negative in 72.7% patients. The rate of isolated muscle involvement was 81.8%. The rate of lower extremity involvement was 72.7%. The most common involvement was leg (36.4%), thigh (18.2%), and shoulder (18.2%). One patient developed compartment syndrome after cyst rupture during neoadjuvant antihelmintic therapy. There was no recurrence in any of the patients.

CONCLUSION

Hydatid cysts should be considered in the differential diagnosis of slowly growing, deeply located, painless soft tissue masses, particularly in endemic areas. Although it is a rare complication, compartment syndrome may develop after spontaneous cyst rupture. Neoadjuvant antihelmintic chemotherapy can reduce complications. The combination of total surgical excision and chemotherapy yields successful results in the treatment of hydatid cysts located in the muscle.

Echinococcal Disease of the Fallopian Tube as a Rare Cause of Primary Subfertility

Echinococcosis is a significant zoonotic infection caused by Echinococcus granulosus, which has a worldwide distribution. In India, the annual incidence varies from one to 200 in 100,000 people. The liver and lungs are often affected, making diagnosis difficult when infections occur in uncommon areas. We report a case of a hydatid cyst in the fallopian tube, which presented as subfertility and was confirmed by radiological imaging.

Zoonotic Transmission of Hepatic Hydatid Cyst from Domestic Dogs: A Case Report from an Urban-Marginal Area in Ecuador

BACKGROUND Hepatic hydatidosis, or echinococcosis, is a zoonosis with worldwide prevalence and is potentially lethal in humans. This report presents a case of hydatidosis in a 40-year-old woman that was associated with a zoonotic transmission of Echinococcus granulosus from domestic dogs in an urban-marginal area of the city of Guayaquil, Ecuador. This report shows how early diagnosis and awareness favored the correct treatment of the disease. CASE REPORT A 40-year-old woman from the aforementioned sector presented the following symptoms: malaise, pain in the upper right hypochondrium, palpable mass, jaundice, and fever. Next, the patient's fecal samples were analyzed by direct coproparasitic methods, flotation, and sedimentation with centrifugation using saline solution, whereby the presence of Entamoeba histolytica eggs was determined. Likewise, she underwent an ultrasound, in which hepatic hydatid cysts were observed. Subsequently, the cysts were treated and surgically removed, and parasitic forms of E. granulosus were identified. Later, coproparasitic analysis of her 2 domestic dogs for coproantigen ELISA were performed, by which the presence of this cestode was also identified and confirmed. CONCLUSIONS Hydatidosis is a zoonosis that can affect the population, especially in endemic areas of developed and underdeveloped countries. In this case, hepatic hydatidosis was identified in a 40-year-old woman. Additionally, the presence of E. granulosus eggs was determined in the fecal matter of her dogs, which indicated that the patient's relatives and other people around them were exposed to this zoonosis.

Primary Hydatid Cyst of the Thigh: Atypical Location and Perioperative Strategies to Minimize Recurrence After Accidental Cyst Rupture

This study presents a rare case of hydatid cyst (HC) located in the left thigh, an atypical site for this parasitic infection, which typically affects the liver and lungs. A 22-year-old female presented with a gradually increasing swelling in the anterior aspect of her left thigh over a period of six months. The diagnosis of the thigh HC was established through a combination of imaging techniques, including ultrasonography and magnetic resonance imaging (MRI), and serological tests. The patient underwent surgical removal of the cyst. We also highlight a management strategy for perioperative accidental rupture of the cyst to minimize the risk of dissemination and reduce the likelihood of recurrence. This report emphasizes the need for a careful multidisciplinary approach to ensure effective diagnosis and successful management of HC, particularly when they occur in atypical locations.

Bilateral hydatid cyst of the breast: a case report and review of the literature

Hydatid cyst disease is a parasitic infestation caused by the tapeworm Echinococcus granulosus. The incidence of the disease is 1-200 cases per 100 000. The usual presentation is the formation of fluid-filled cysts in the liver or lungs and, less commonly, in the brain. The breast is a rare site of presentation for this disease. An isolated hydatid cyst in the breast is very rare, even in endemic regions, occurring in only 0.27% of all hydatid cases. Although these cases are very rare, they should be considered severe. A hydatid breast cyst may mimic a fibroadenoma, phyllodes tumor, chronic abscess, or even carcinoma. Therefore, a high incidence of misdiagnosis may occur. Preoperative diagnosis can be made using needle aspiration and imaging facilities such as breast ultrasonography, mammograms, and computerized topographic images. Nevertheless, in most cases, the final diagnosis cannot be made until the pathological report is obtained postsurgery. This paper reports the first case of a bilateral hydatid cyst of the breast that was diagnosed preoperatively by radiological facilities. We present the patient history, physical examination, and investigations, discuss the risk factors, and present our treatment plan.

A rare location of cardio hydatid cyst with multiple organ involvement: a case report

Cardiac cysts in hydatid cysts, a parasitic disease, are extremely rare, and left-atrial hydatid cysts are even more unusual. Therefore, the authors report herein a rare case of a hydatid cyst in the left atrium. According to them, this is the third documented case of left-atrial hydatid cysts.

Presentation of Case

A 25-year-old male presented at the outpatient clinic with atypical chest pain, hacking cough, dyspnoea, nausea, and vomiting for 2 months. Echocardiography showed a left-atrial unilocular, well-delineated mass. The authors also found multiple liver cysts and spleen cysts.

Discussion

The widespread distribution of the disease in our regions, the dog contact story of the patient, and the appearance on echocardiograms were strong reasons to diagnose a hydatid cyst in the left atrium, which may cause many symptoms (bundle branch conduction, arrhythmias, myocardial infarction) or unexpected death.

Conclusions

The authors aimed to report this case due to the disease's high probability of death, even asymptomatic patients with cardiac hydatid disease should all be referred for early surgery.

Primary costal hydatid cyst resembling urolithiasis: A case report

INTRODUCTION

Hydatid disease (HD) is a zoonotic infection caused by echinococcus granulosus tapeworms. HD accounts for approximately one million cases worldwide. HD is more prevalent in endemic areas, such as the Mediterranean region.

PRESENTATION OF CASE

A middle-aged male patient presented with right flank pain for years. His vital signs and physical examination were unremarkable. The whole-body bone scan revealed an area along the sixth rib's posterior arch with increased metabolic activity and CT and MRI were compatible with a hydatid cyst. The cyst was surgically resected and irrigation of the area with hypertonic saline was done. Medical treatment with albendazole was initiated and the patient had no complications.

DISCUSSION

Bone involvement is an uncommon finding in HD and involvement of the ribs is even more scarce. Surgical resection complemented with medical treatment is the preferred approach.

CONCLUSION

In the Mediterranean and middle eastern regions, high infection rates with E. granulosis are evident hence, uncommon manifestations of the disease should be regarded. Although renal stones are far more prevalent when in endemic areas of HD, the physician should also consider skeletal HD as a differential diagnosis.

Cardiac Echinococcosis With Hepatic Involvement in a Child: A Case Report

Hydatidosis is endemic in Morocco. Cardiac localization of hydatid disease is a rare entity. Involvement of the interventricular septum is even rarer. We report the case of a 6-year-old girl with combined hepatocardiac hydatid disease. She was admitted with complaints of dyspnea, asthenia and vomiting. Ultrasound imaging and CT scan showed cystic lesions in the interventricular septum and in the liver. Serologic test results were positive. According to the biological and radiological findings, the diagnosis of echinococcosis with cardiac and hepatic involvement was suggested. Complete excision of the cardiac cyst was performed followed by anthelminthic treatment with albendazole as a supportive therapy. The confirmative diagnosis of hydatid disease was made by microscopic examination of the removed material. Our patient was referred to the department of general surgery to treat the liver lesions in the future. The postoperative period was unremarkable.

Total Resection of Intraorbital Hydatid Cyst by Using Lynch Approach: A Case Report

Hydatidosis is a chronic zoonotic infection of humans caused by the infestation of larvae of the tapeworm Echinococcus granulosus. All parts of the body can be infected, especially the liver and lungs. Intraorbital hydatid cyst (HC) is a rare entity and accounts for less than 1% of all hydatid cysts. Total resection of the cyst can be very challenging due to the limited area within the orbit and the severe adhesion to adjacent structures. Several surgical approaches have been described in the literature depending on the size and location of the cyst. We reported a case of retrobulbar HC in a 10-year-old boy which was completely resected using the Lynch approach. Our case should be the second reported case from Syria and the first case that used the Lynch approach in the literature.

Effective Factors on the Disappearance of Residual Cavity Following Conservative Surgery of Liver Hydatid Cysts

Background:

Surgery is one of the treatments commonly used to treat liver hydatid cyst. Remaining of the residual cavity after conservative surgery may lead to some harmful complications. In this study, we evaluated the role of different factors affecting the disappearance of the residual cyst.

Materials and Methods:

Seventy-five patients were evaluated in 2.5 years. Patients were divided into two groups based on the remaining or disappearance of the residual cavity in follow-up visits. The baseline demographic features, preoperative cysts’ size, type of technique used to eliminate the residual cavity, and cavity wall characteristics were compared in the two groups.

Results:

Residual cavity was disappeared in 46 (61%) patients after 2 years. Calcification of the wall and wall stiffness were more common in patients with the remained residual cavity (89.6% vs. 8.7% [P < 0.001] and 58.6% vs. 30.4% [P < 0.01], respectively). Demographic features, preoperative cysts’ characteristics, and the procedure used during surgery were not statistically different between groups.

Conclusions:

Cyst wall calcification and wall stiffness had a role in predicting residual cavity disappearance. These factors can help surgeons to predict patients at higher risk of posthydatid cyst resection residual cavity.

An Unusual Cause of Knee Mass: Osseous Hydatidosis

Hydatid disease (hydatidosis) is a zoonotic infection caused by the larval stage of the parasitic tapeworm Echinococcus granulosus endemic in some sheep-raising areas. The liver and lungs are most commonly affected. Bone involvement (osseous hydatidosis) is distinctly uncommon, and its diagnosis and treatment can be challenging. We report a case of a 54-year-old male with right knee pain and edema and an extensive lesion on the femur; he was diagnosed with knee hydatidosis and was successfully treated with surgery and albendazole. This case reinforces the importance of the rare osseous hydatidosis as part of the differential diagnosis of bone lesions.

Hydatid Cyst in Liver Masquerading As Metastatic Deposits From Ovarian Carcinoma

Metastatic deposits from primary ovarian malignancy can manifest as cystic masses in the liver. In endemic areas, hydatid disease is an important differential in all cases of cystic hepatic masses. We report a case of a 55-year-old lady who presented with progressive abdominal distension and was diagnosed with primary ovarian high-grade serous carcinoma. Imaging revealed concurrent lesions in the liver that were thought to be metastatic deposits but was later diagnosed as hydatid cyst based on radiologic features and serology. We report this rare case to highlight the importance of suspecting a hydatid cyst in endemic areas and its varied manifestations.

Spontaneous Hepatic Hydatid Cyst Rupture Into the Transverse Colon

Hydatid disease is a prevalent parasitic infestation caused by the cestode Echinococcus granulosus in predominantly rural areas of the Mediterranean region, South East Asia, Australia, and South America. This report discusses a unique case of a 32-year-old lady who presented to the Emergency Surgery Department with complaints of abdominal pain, distension, and constipation for five days. Radiological investigations showed air-fluid levels within a large cyst originating from the liver. Surgical exploration revealed a large hepatic hydatid cyst communicating with the transverse colon with the presence of multiple peritoneal hydatid cysts. Evacuation of the cyst contents, lavage, and excision of the rest of the hydatid cysts was done. Dense adhesions were present involving the liver, large bowel, and duodenum. Therefore, a terminal ileum diversion loop ileostomy was made. Ileostomy was reversed after checking the large bowel anatomy with a distal loopogram.

Echinococcosis of the spine

Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine.More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization.This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients' outcomes.The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130.

Progressive compressive myelopathy induced by a rare primary isolated thoracic vertebral hydatid cyst: A case report

RATIONALE

Hydatid cyst is a disease caused by the larvae of Echinococcus spp. The larvae often reside in the liver, lungs, and brain. Occasionally, a primary isolated thoracic vertebral hydatid cyst is reported to cause severe complications. Various diseases may lead to the development of progressive compressive myelopathy. Herein, we report a rare case of a primary isolated thoracic vertebral hydatid cyst with compressive myelopathy.

PATIENT CONCERNS

A 57-year-old female had numbness and weakness in the lower limbs for a span of 3-months.

DIAGNOSIS

Thoracic magnetic resonance imaging (MRI) showed that an isolated mass was observed in the T5 vertebral body, which compressed the spinal cord. The diagnosis was confirmed after surgical excision, and Echinococcus granulosus was found to be the etiologic factor.

INTERVENTIONS

The patient underwent laminectomy with no complications.

OUTCOMES

After surgical decompression, the patient made slow and measurable progress. While relatively rare in the non-pastoral area, the primary isolated thoracic vertebral column hydatid cyst may be considered as a possible etiology of atypical extradural spinal compression.

LESSONS

This case illustrates the complexity of spinal echinococcosis manifestations and the necessity of an interdisciplinary approach.

One-stage surgery for both hepatic and left ventricular hydatid cysts using transthoracic route

Hydatid disease is a major health problem. Multiorgan involvement including the heart and the liver is a very rare presentation. Management of multivisceral hydatidosis through a sole incision should be considered when possible. Median sternotomy is considered in our case.

Incidental Asymptomatic Giant Hydatid Cyst of the Interventricular Septum Bulging Into the Right Ventricle

Hydatid disease is caused by the larvae of Echinococcus granulosus. Domestic animals like cats and dogs are the primary carriers of echinococcal organisms. This parasitosis is still endemic in some particular regions of the world. The cardiac hydatid cyst is an exceptional infection. We report a case of an asymptomatic giant cardiac hydatid cyst in the interventricular septum (IVS) protruding in the right ventricular diagnosed incidentally by scan tomography during acute pancreatitis emergency. Transthoracic echocardiography revealed a cystic mass in the IVS bulging into the right ventricle. The diagnosis was confirmed by a cardiac CT scan.

MicroRNA expression profile in patients with cystic echinococcosis and identification of possible cellular pathways

Cystic echinococcosis (CE) is a neglected tropical disease, caused by metacestode (larval) form of the Echinococcus granulosus sensu lato (sl) in humans. MicroRNAs (miRNAs) are small, stable, tissue-specific RNA molecules encoded by the genome that are not translated into proteins. Circulating miRNA expression profiles vary in health and disease. The aim of this study is to determine the altered cellular pathways in CE by comparing the miRNA profiles of controls and CE patients with active or inactive cysts. Following abdominal ultrasonography (US) examination, 20 patients diagnosed with active CE (CE1, CE2, CE3a and CE3b) or inactive CE (CE4 and CE5) and three healthy controls were included in the study. The expression profiles of 372 biologically relevant human miRNAs were investigated in serum samples from CE patients and healthy controls with miScript miRNA HC PCR Array. Compared with the control group, expression of 6 miRNAs (hsa-miR-4659a-5p, hsa-miR-4518, hsa-miR-3977, hsa-miR-4692, hsa-miR-181b-3p, hsa-miR-4491) and one miRNA (hsa-miR-4687-5p) were found to be downregulated in CE patients with active and inactive cysts, respectively (p < 0.05). For downregulated miRNAs in this study, predicted targets were found to be associated mainly with cell proliferation, apoptosis, cell-cell interactions and cell cycle regulation. Further studies in this direction may elucidate the pathogenesis of human CE and the relationship between CE and other pathologies.

Lytic parasitic: a case of bone destructing echinococcosis

Pelvic hydatid bone disease is a rare and debilitating condition. Patients often present with symptoms and signs when the disease process is advanced and curative resection is not possible. We present a case of destructive bone hydatid disease affecting the left iliac bone. A 45-year-old woman presented initially 5 years ago with a left pelvic mass to the gynaecology department. Computed tomography (CT) scan done at that time showed a large pelvic, left iliac fossa cystic mass with the destruction of the left iliac bone. Extension of the cystic mass transversed the iliac bone into the posterior soft tissue. Percutaneous biopsy taken showed hydatid cystic disease. The patient was planned for surgery and, however, was lost to follow-up. Four years later, she presented with a history of worsening left pelvic pain with an enlarging, left pelvic mass, and another mass in the posterior gluteal area. In addition, CT imaging showed extensive left iliac bone destruction with posterior soft tissue extension to the gluteus muscle. A multidisciplinary team concluded that complete excision would not result in cure. Thus, complete iliac wing bone reconstruction was not an option in this patient. Instead, palliative measures were deemed in the patient's best interest to control disease progression and relieve painful pressure-related symptoms from the hydatid cystic mass. The patient received preoperative albendazole and underwent an extraperitoneal debulking of the soft tissue hydatid infiltration and debridement of bony fragments from left iliac bone destruction. Postoperatively, the patient did well, and her main complaint of pain related to the cystic mass pressure had improved significantly.

Surgical Management of Cardiac Hydatid Cyst and the Residual Intramural Ectocyst

The cardiac hydatid cyst (HC) is a rare pathology and mostly is endemic in livestock raising countries. Patients do not have a specific presentation so it is mainly a diagnosis based on imaging. Finding HC anywhere in the body warrants looking for another hydatid in other organs. This is a case report of a young male who presented with nonspecific symptoms and during diagnostic workup, it happened that he has combined hepatic and cardiac HCs. The cardiac cyst was located intramurally in the interventricular septum and expanding down mostly to the left side of the diaphragmatic surface of the heart and partly crossing intramurally to the diaphragmatic surface of the right ventricle. Emergency open-heart surgery was performed; the endocyst was removed while intramural ectocyst was drained to prevent potential future residual space.

[Study on effect of echinococcus granulosus protoscolices on fibrosis of bone marrow mesenchymal stem cells]

Objective

To investigate the effect of echinococcus granulosus protoscolices on the differentiation of bone marrow mesenchymal stem cells (BMSCs) into fibroblasts.

Methods

Femur bone marrow of 4-week-old C57BL/6 mice was taken and BMSCs were isolated and cultured by adherent culture. Echinococcus granulosus protoscolices was extracted from the liver of sheep infected with echinococcus granulosus. The experiment was divided into two groups. The experimental group was co-cultured with the 3rd generation BMSCs and the echinococcus granulosus protoscolices, and the control group was the 3rd generation BMSCs. Before and after co-culture, the morphology of BMSCs and the activity of echinococcus granulosus protoscolices were observed by inverted microscope. After cultured for 1, 3, 5, and 7 days, the mRNA expressions of transforming growth factor β ₁ (TGF-β ₁), collagen type Ⅰ, and collagen type Ⅲ were detected by real-time fluorescent quantitative PCR, the protein expressions of TGF-β ₁, collagen type Ⅰ, collagen type Ⅲ, Smad7, and phosphorylated Smad2/3 were detected by Western blot, and the contents of collagen type Ⅰ and collagen type Ⅲ in the supernatant of the two groups were detected by ELISA.

Results

After 7 days of co-culture, the morphology of BMSCs changed into fusiform and irregular triangle, which was closer to the mouse fibroblasts. The relative mRNA expressions of TGF-β ₁, collagen type Ⅰ, and collagen type Ⅲ in the experimental group were significantly higher than those in the control group; the relative protein expressions of TGF-β ₁, collagen type Ⅰ, collagen type Ⅲ, and phosphorylated Smad2/3 in the experimental group were significantly higher than those in the control group, and the relative protein expression of Smad7 in the experimental group was significantly lower than that in the control group; the contents of collagen type Ⅰ and collagen type Ⅲ in the supernatant of the experimental group were significantly higher than those in the control group. The differences between the two groups were significant ( P<0.05).

Conclusion

Echinococcus granulosus protoscolices may promote the secretion of collagen type Ⅰ, collagen type Ⅲ, and TGF-β ₁ by TGF-β ₁/Smad signal pathway, which can promote the fibrosis of BMSCs that related to the formation of fibrocystic wall by echinococcosis.

Cardiac Hydatid Cyst Successfully Managed with Albendazole: A Case Report

Hydatid disease is a parasitic infection caused by tapeworm Echinococcus. It has a worldwide distribution, but it is endemic in certain geographic locations. Hydatid disease can almost involve any body organ. However, cardiac involvement is exceedingly rare. We report the case of young girl presenting with chest pain and shortness of breath. She had a history of renal hydatid cyst for which she underwent surgical resection. After thorough investigation, she was found to have a hydatid cyst involving the left ventricular wall. The patient's family refused surgical management, and she had received medical treatment in the form of albendazole which showed dramatic improvement in her condition. This case shed light on the importance of having a high index of suspicion for this condition, particularly in those patients with a history of hydatid cysts in other organs.

Laparoscopic Management of Initially Unrecognized Splenic Hydatid Cysts: A Case Report and Review of the Literature

We present a case report that demonstrates diagnostic and intraoperative challenges in the laparoscopic management of initially unrecognized splenic hydatid disease. A male patient, aged 44, was admitted to our department with a big unilocular splenic cyst, radiologically (ultrasonography, computed tomography) characterized as a simple cyst. Serological tests for anti-Echonococcus antibody were negative, and chests X-ray findings were unremarkable, so laparoscopic cyst fenestration with omentoplasty was planned. The intraoperative finding did not correspond to a simple splenic cyst. Hydatid daughter cysts were recognized after the careful opening of the cyst wall. The operation was completed without shifting to open procedures. Laparoscopic partial pericystectomy with omentoplasty is a safe and effective surgical procedure for the management of splenic hydatid disease.

Intrapelvic Localised Hydatid Cyst

Hydatid cysts, caused by Echinococcus granulosus, is an important health problem in endemic areas. The disease can localize most commonly in the liver and lungs. Primary pelvic involvement is a rare condition. In this case report, we aimed to present a 75-year-old male patient with a pelvic mass, which was diagnosed preoperatively as a hydatid cyst.

Efficacy and safety of ultrasound-guided percutaneous microwave ablation for the treatment of hepatic alveolar echinococcosis: A preliminary study

The present study aims to assess the efficacy and safety of ultrasound-guided percutaneous microwave ablation (MWA) for hepatic alveolar echinococcosis (HAE) preliminarily.Seventeen patients diagnosed to HAE and treated with MWA (80 watts, 4 min) were retrospectively analyzed. The upper abdominal computed tomography (CT) was performed at 1, 6, 12 months after the MWA treatment. The complications were evaluated to assess the safety.The diameters of the lesions in the HAE patients ranged from 1.9 to 4.7 cm. The patients included 10 males and 7 females, aged 26 to 70 (45.82 ± 13.36) years, 5 patients infecting with chronic hepatitis viral B and 8 patients with positive hydatid antibody (IgG). The lesions observed in the postoperative CT (1, 6, 12 months) were calcified compared with those observed in the preoperative CT and without relapse. No serious treatment-related complications occurred after treatment.MWA is a novel and effective therapeutic method for HAE with a single lesion (diameter≤=5 cm). Further studies based on prospective random control trials to confirm our findings are necessary.

An unusual radiological presentation of a pulmonary hydatid cyst in a child

Giant pulmonary hydatid cyst is usually encountered in adolescents and children who are older than 10 years. A relatively higher elasticity of the lung tissue allows rapid growth of cysts. We present a case of a 15-year-old male who was admitted with complaint of frequent and persistent dry cough for over a month. Computed tomographic scan revealed a giant cyst with thick enhancing rim and an "air bubble" sign. Diagnosis of giant hydatid cyst was confirmed by surgery and histopathological examination.

Differential diagnosis and management of a recurrent hepatic cyst: a case report and review of literature

Echinococcus granulosus, which causes cystic echinococcosis, is an uncommon condition in the United States. We report a case of a 78-year-old Caucasian female who presented to her primary care physician in 1999 with right upper quadrant pain. She had a history of frequent foreign travel. Abdominal imaging demonstrated a 12.5-cm hepatic cyst. The cyst was drained and the pathology report on the fluid indicated no bacterial, parasitic, or malignant etiology. Serology tests for Entamoeba and Echinococcus antibodies were negative. The patient underwent multiple hepatic cyst aspirations until 2008 for recurring symptoms. In 2008, abdominal imaging demonstrated solid internal components within the cyst. Repeat Echinococcus antibodies ordered were abnormally elevated. Cyst aspiration demonstrated Echinococcus protoscolex. We report this case to discuss the diagnosis and management of hydatid cyst and to emphasize that with increasing globalization, physicians must maintain a high index of clinical suspicion for parasitic etiologies in patients with hepatic cysts.

Spinal hydatid cyst mimicking arachnoid cyst on magnetic resonance imaging

BACKGROUND

Primary spinal hydatid cysts are uncommon and account for 1% of all cases of hydatid disease. Echinococcus granulosus is most often responsible for the cyst hydatid. Intradural, extramedullary involvement is rare. When the cysts do not demonstrate typical magnetic resonance imaging findings, the differential diagnosis is more complex.

METHOD

Case report.

FINDINGS

An isolated primary hydatid cyst of the spine in a 35-year-old man that appeared to be an arachnoid cyst on preoperative radiographic examination.

CONCLUSION

Hydatid cysts that lack the typical radiographic appearance may be mistaken for arachnoid cysts. Misdiagnosis has serious implications for surgical intervention and long-term care.

Clinical presentations and surgical management of liver hydatidosis: our 20 year experience

BACKGROUND

Hydatidosis/echinococcosis of the liver is a very old problem in Greece and still exists, although it is declining. We have reviewed our 20 years' experience, and here we report the various clinical presentations of the disease and evaluate the clinical outcome of the surgical procedures performed.

PATIENTS AND METHODS

We conducted a retrospective analysis of the past 20 years' medical records; 35 patients (males 34%, females 66%, mean age 58 years) were treated surgically. Results. The presenting symptoms or findings leading to the diagnosis of liver echinococcosis were jaundice (six cases, 17%), abdominal pain (five cases, 14%), gastrointestinal discomfort of the upper abdomen (e.g. nausea, vomiting, distention, anorexia) (two cases, 6%), acute pancreatitis (one case, 3%) and portal hypertension (one case, 3%). The rest of the cases were diagnosed incidentally (20 cases, 57%). External drainage and cystectomy with omentoplasty was performed in 21 cases (60%) and pericystectomy in 14 cases (40%). The mean hospital stay was 16.8 days. Morbidity and mortality were 18% and 3%, respectively, with no statistically significant differences between the two surgical approaches. The recurrence rate averaged 3%.

DISCUSSION

A high index of suspicion is recommended when variable clinical manifestations of the upper abdomen are present. Meeting all criteria for surgical treatment of hydatid disease, external drainage and cystectomy should be the standard surgical procedure. Pericystectomy could be used for peripherally located liver cysts that are only partially surrounded by parenchyma. Resection procedures are considered too radical for a benign disease. Appropriate randomized controlled studies are needed to establish the definite surgical management of liver hydatidosis, including modern techniques such as laparoscopy and transcutaneous puncture under US guidance (PAIR technique).

Giant cell reaction against the laminated membrane of echinococcus cysts in reindeer lungs

In 23 pairs of lungs from reindeer two to five years of age, two types of hydatid cysts of Echinococcus granulosus were found: typical well-developed cysts and collapsed degenerated cysts.

Collapsed cysts were found in 13 pairs of lungs, well-developed in nine pairs, while both types of cysts were found in one pair of lungs.

A giant cell formation was present in the innermost zone of the surrounding adventitial membrane of both collapsed cysts and well-developed cysts. The giant cell reaction seemed to be induced by and directed against the laminated membrane. In the areas of the cysts where the laminated membrane showed a close contact with the adventitial membrane, the giant cells seemed to be actively engaged in the inflammatory process. On the contrary, in the areas of the cysts where the laminated membrane had lost contact with the adventitial membrane, the giant cells were degenerated or necrotic, and the space between the membranes was filled with necrotic cells. In cases where the laminated membrane had been pronouncedly disintegrated, the giant cells were also necrotic or nonexistent.

The giant cell reaction which was found even in comparatively young fertile cysts suggests that the reindeer variant of E. granulosus, if such exists, is not especially well-adapted to the reindeer as its intermediate host.

Prevalence of echinococcosis in reindeer (Rangifer tarandus) in Sweden

In Sweden echinococcosis is uncommon in domestic animals. In reindeer in the most northern part of the country echinococcosis was found. Of 1453 pairs of lungs, 23 pairs (1.6 %) were infected with hydatid cysts. These were of two types: typical well-developed hydatid cysts, which were found in nine of the 23 infected lungs, and collapsed hydatid cysts, which were found in 13 of the lungs. In only one lung pair both types of cysts were seen.