Surgical excision for gigantic bilateral pulmonary hydatid cyst in a 14-year-old adolescent: A case report study

INTRODUCTION AND IMPORTANCE

Bilateral pulmonary hydatid cysts in adolescents are rare and present unique diagnostic and treatment challenges. Adolescents with pulmonary hydatid disease often present with nonspecific symptoms such as cough, abdominal pain, nausea, vomiting, and hepatosplenomegaly.

CASE PRESENTATION

This case is about 14-year-old adolescent who reported feeling a mass in his chest and experienced a loss of appetite. Imaging studies were performed which showed the presence of bilateral hydatid cyst in the lung. The cyst contents were sent for histopathological analysis, which confirmed the diagnosis of hydatid cysts.

CLINICAL DISCUSSION

The clinical presentation of hydatid cysts varies depending on the organs involved. Bilateral hydatid cysts may occur in various organs such as liver, lung, brain, spleen, kidney, bone and other sites. Diagnosis of bilateral hydatid cysts in adolescents is difficult because symptoms may be nonspecific and the cysts may not be apparent until they reach a sufficient size. The type of surgical approach depends on the location, size, and number of cysts.

CONCLUSION

Bilateral pulmonary hydatid cysts have become an increasingly important diagnosis in adolescent patients. Imaging plays a critical role in prompt diagnosis, and surgical intervention remains the mainstay of management. There are limited studies regarding the management of such rare cases, but through a multidisciplinary approach, improved outcomes can be achieved.

A rare case of bilateral para-rectal hydatid disease: A case report

INTRODUCTION

Cystic hydatidosis is a parasitic infection caused by the organism Echinococcus Granulosus that is well known to be endemic in the Mediterranean region, eastern Europe and South America and usually presents as hydatid disease of the liver but may affect other organs. The disease occurs when humans become the accidental host through ingestion of the eggs from contaminated food.

CASE PRESENTATION

We present a case of Hydatid disease presenting as hives refractory to medical therapy over 4 years duration which was revealed to be caused by para-rectal hydatid cysts. Patient received Albendazole for a duration of 2.5 months and then underwent laparoscopic resection of the para-rectal cysts.

CLINICAL DISCUSSION

Pelvic Hydatidosis is a very rare condition accounting for 0.7 % of all cases reported. In most cases, it is coexistent with cysts present elsewhere in the body, namely the liver, which is the case in the presented patient. Imaging is used as a modality to establish the diagnosis of cystic hydatidosis namely Ultrasound (US), Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI). The incidental finding of the hydatid cysts in this patient demonstrated the efficiency of a CT scan as a tool for detection and subsequently diagnosis of the disease in the pelvis. Surgery is the treatment of choice for cysts with daughter vesicles that are not candidates for percutaneous drainage, large liver hydatid cysts of more than 10 cm in diameter, cysts with a risk of rupture in case of trauma, and extrahepatic disease such as the lung, bone, brain, kidneys or pelvis.

CONCLUSION

This article reports the rare occurrence of para-rectal hydatid disease which is only described in few case reports in the literature and provides an overview on diagnosis, and management of the disease.

Isolated Primary Hydatid Disease Of The Breast

Our study is relevant because our report adds further light on diagnosing and treating the isolated primary hydatid cyst disease of the breast. The purpose of this case report is to educate physicians and health care workers to keep this condition in the differential diagnosis of the breast lump even though the breast is a rare site of primary hydatid disease even in the endemic areas. Awareness of this entity can help in arriving at a pre-operative diagnosis, even without cytological examination, which is important in the management of the cyst. This is the first of its kind case being reported from Pakistan.

Cardiac hydatid cyst presenting as ventricular arrhythmia: a case report

Background

Hydatid disease caused by Echinococcus granulosus commonly involves the liver followed by lungs. Cardiac involvement is a rare occurrence and presents a challenging scenario.

Case presentation

Our case describes a middle-aged gentleman who presented to the emergency room with an episode of sudden loss of consciousness resulting from ventricular tachycardia. After successful cardiac resuscitation, the patient underwent imaging that showed a lesion compatible with hydatid cyst. Surgical treatment with pharmacologic coverage was provided which resulted in good clinical outcome.

Conclusions

The case highlights rare occurrence of isolated cardiac hydatid disease presenting as cardiac arrhythmia in contrast to its common routine outpatient presentation involving the liver and lungs. Good knowledge of the unusual presentations and its epidemiology is essential to the proper management of such patients.

Hydatid disease presenting as dense breast implant

We present an interesting case of a pulmonary cyst, thought from the original radiograph to be a dense breast implant. We also present a computed tomography image of the large cyst and the characteristic histological findings of the cause.

Wandering parasite: endoscopic management of hydatid cysts of abdomen encroaching thorax

BACKGROUND

Minimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy should be evaluated for its feasibility and efficacy.

AIM

Present prospective study was designed to highlight the feasibility and utility of endoscopic approach in the management of complex hydatid cyst of the liver and spleen extending into the thorax.

MATERIAL AND METHODS

Patients undergoing combined Laparoscopy and thoracoscopy for abdominal hydatid cysts extending into thorax over a period of 4 years were included in the study. Their clinical features, investigations, imaging, treatment and duration of hospital stay were studied. Clinical outcomes were assessed with respect to morbidity and mortality using Calvien Dindo scale.

RESULTS

A total of 15 patients were studied. All patients had thoracic hydatid cysts with liver involvement in 12, splenic involvement in 2, and both liver and spleen in 1 patient. The most common symptom was pain in the abdomen in 11 patients (73.3%) followed by lump in the abdomen in 2 patients (13.33%), and dyspnoea in 2 patients (13.33%). Computed Tomography was diagnostic in all patients. Most common type was Gomez type 1 (7 patients) followed by Gomez type II (3 Patient) and Gomez type III (2 patient). The mean operative time was 120 min. Mean hospital stay was 10 days. Pleural effusion being the commonest postoperative sequelae.

CONCLUSION

This endoscopic approach for liver and splenic hydatid cyst extending into thorax is feasible and averts morbidities of thoracotomy.

An Update on the Epidemiological Features of Imported Schistosomiasis and Cystic Echinococcosis in Kuwait, 2010-2018

OBJECTIVE

Kuwait is considered a non-endemic country for most parasitic infections. However, ∼70% of 4.7 million residents in Kuwait are expatriates from Asian and African countries, which are endemic for parasitic infections. Results of microbiological investigations for schistosomiasis and cystic echinococcosis (CE) performed in a reference national laboratory were retrospectively collected and analyzed to provide an insight on the epidemiology of these 2 neglected tropical diseases in Kuwait.

SUBJECTS AND METHODS

Schistosoma infection in fecal and urine specimens from suspected patients was detected by microscopy. Schistosoma and CE infections were also detected by indirect hemagglutination assays (IHAs) using blood specimens. Patients' epidemiological data were extracted from the laboratory records.

RESULTS

The overall prevalence rates of schistosomiasis and CE were 19.0 and 5.8%, respectively. Almost all schistosomiasis cases were seen among Egyptians, especially among males, and a significantly higher prevalence (p < 0.05) was seen for CE cases among the Syrian residents. A decreasing annual trend was observed for both the parasitic infections over time in Kuwait.

CONCLUSIONS

This study confirmed that schistosomiasis is not autochthonous in Kuwait, as all cases were detected among expatriates from Schistosoma-endemic countries. Our data also showed that CE remains endemic among humans and livestock in Kuwait as is also seen in other Middle Eastern countries.

An Intraoperative Surprise! A Rare Case Report of Primary Craniovertebral Junction Hydatid Disease Mimicking a Bony Tumor

BACKGROUND

Craniovertebral junction (CVJ) hydatid disease, although rare, forms an important differential diagnosis of CVJ bony pathologies, especially in endemic areas due to the sheer volume of cases presented there. The authors report a rare case of CVJ hydatid disease mimicking a bony expansile tumor on imaging.

CASE DESCRIPTION

A 21-year-old woman presented with a left-sided neck tilt and pain for 3 months, intermittent low-grade fever, and features of high cervical myelopathy (Nurick grade II). Magnetic resonance imaging and computed tomography imaging showed a solid enhancing mass with numerous small cystic areas with bony erosion of the basiocciput, C1 and C2 vertebrae, suggestive of an expansile bony lesion (osteoblastoma/giant cell tumor/aneurysmal bone cyst). She underwent a posterior approach for decompression and spinal fixation, and multiple clear grape-like cysts were encountered that were confirmed to be hydatid cysts on histopathology. All visible cysts were excised and instrumented fusion of the CVJ performed. Albendazole was continued for 6 weeks and at 3 months' follow-up, the patient remains asymptomatic with no recurrence on imaging.

CONCLUSIONS

The authors conclude that in tropical regions, hydatid disease of the cervical spine should be considered in the differential diagnosis of patients presenting with high cervical compressive myelopathy, especially when associated with fever. Spinal hydatosis may mimic a bony lesion on imaging and should be kept in mind, as in addition to routine decompression, use of scolicidal agents and intact removal of cysts have a significant effect on reducing the recurrence rate and improving the outcome.

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.

Thoracic hydatid disease: A radiologic review of unusual cases

Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lung is the second most commonly affected organ after the liver. Intra-thoracic and extra-pulmonary hydatid disease is uncommon and may involve the pleura, mediastinum, heart, diaphragm, and chest wall. Unusual locations or complications of thoracic hydatid disease may pose a diagnostic challenge. We present imaging findings of cases with unusual location and presentations of thoracic hydatid disease with emphasis on their clinical implications.

Vertebral hydatid cyst infection. A case report

Hydatidosis is a common parasitic zoonosis in Middle Eastern, African, and Mediterranean populations whit primarily and well known involve of liver and lungs, but some complications are extremely rare and underrated. Particularly Hydatid cystic disease of the skeletal is one of the rarest clinical manifestations and when occurs involve in almost 50% of cases the spine. This manifestation is extremely debilitating, hard to correctly identify and manage. We want to underline this rare involve of spine to avoid misdiagnosis and complications.

Bone marrow-derived mesenchymal stem cell (BM-MSC): A tool of cell therapy in hydatid experimentally infected rats

This study aimed to clarify the potentiality of bone marrow mesenchymal stem cells (BM-MSC) transplantation with albendazole (ABZ) on the modulation of immune responses against hydatid cyst antigens and the regeneration of injured livers in experimentally infected rats. Three different antigens of hydatid cyst fluid (HCF), hydatid cyst protoscolex (HCP) and hydatid cyst germinal layer (HCG) were isolated and their antigenic potencies were determined. The ultrasound, immunological and pathological criteria were investigated. Counting of 80% confluence BM-MSC was 4.68 × 104 cells/cm2 with 92.24% viability. Final population doublings score was 65.31 that indicated proliferation and self-renewability. Phenotyping of BM-MSC showed expression of CD73 and CD29 without exhibition of CD34 and CD14. Ultrasound examination showed multiple hydatid cysts in liver with low blood flow and spleenomegaly 8 weeks' post infection. No significant differences were noted in cystic diameter in uni-cyst liver at 2nd and 4th weeks following ABZ treatment while it was significantly decreased (P < 0.05) following transplantation of BM-MSC + ABZ treatment comparing to experimentally infected untreated group. Igs and IgG responses to the three antigens were significantly elevated while elevation in IgM response was only to HCG (P < 0.05). ABZ treatment accompanied with significant decrease in Igs and IgG titers against HCF and HCG only at 4th week post treatment (P < 0.05). However, Igs titer against HCF, HCP and HCG was significantly decreased at the 4th week following transplantation of BM-MSC + ABZ. Interestingly, the combination of BM-MSC + ABZ treatment resulted in reduction of Igs response to HCP to normal level as that of healthy control. Experimental infection resulted in elevation of TNF-α and IL-6 (P < 0.05) while, IL-4 and IL-10 decreased (P < 0.01). After transplantation of BM-MSC + ABZ treatment, serum TNF-α and IL-6 concentrations were reduced (P < 0.05) at both the 2nd and 4th weeks. However, IL-4 and IL-10 concentrations were significantly elevated (P < 0.05) only at 4th week following transplantation of BM-MSC + ABZ treatment. In conclusion, BM-MSC transplantation following ABZ administration can regenerate injured liver tissue without complete disappearance of hydatid cyst. In addition, it can modulate host protective humeral and cell mediated immune responses against hydatid cyst antigens. Therefore, the current study encourages to move to the step of performing clinical trials in humans.

Geographical distribution and risk factors for Echinococcus granulosus infection in peri-urban wild dog populations

The transmission of zoonotic pathogens associated with wildlife in peri-urban environments can be influenced by the interplay of numerous socioecological factors. Echinococcus granulosus is known to be common within peri-urban wild dog populations however knowledge of the factors that influence its presence is limited. We investigated the demographic distribution of adult cestode abundance (ACA: defined as the product between prevalence of infection and adult cestode infection intensity) and the role of the physical environment, climate and individual factors in determining the geographical variation of E. granulosus infection in wild dog populations from southeast Queensland and surrounds. Our results align with previous studies that show significant E. granulosus aggregation in that 15.8% of peri-urban wild dogs sampled were responsible for ∼70% of the total adult cestode infection intensity. On average, female dogs were found to have a higher ACA than male dogs, and the average ACA generally decreased with age. Significant geographical variation was found in the prevalence of E. granulosus, with a strong propensity for clustering. The average size of clusters was 22.5 km. The probability of finding E. granulosus infection significantly increased with maximum temperature, relative humidity, and rainfall, and after accounting for individual and climatic variables, the model accounted for the majority of the spatial dependence in prevalence. Our predictive map of E. granulosus prevalence in peri-urban wild dogs confirms that E. granulosus is highly endemic in the eastern Australia study area. The prediction map provides a useful tool for targeting potential disease management strategies in peri-urban areas, where broad scale management of wild dog populations is difficult to implement.

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E. granulosus is common in peri-urban wild dog populations.

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E. granulosus worm burdens in peri-urban wild dogs are highly aggregated.

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Bitches and pups have higher adult cestode infection intensity than males and older animals.

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High endemic regions of E. granulosus are present within human developed environs.

First description of Echinococcus ortleppi infection in China

Background

Echinococcosis has led to considerable social and economic losses in China, particularly in the endemic communities of the eastern Tibetan Plateau. In China, human cases of Echinococcus granulosus (sensu stricto), E. canadensis and E. multilocularis infections have been described, but no E. ortleppi (G5) infections in humans or animals have been reported.

Results

A case of E. ortleppi infection in a human from Guangxi, which is a non-endemic echinococcosis area in China, is described. A 17 × 12 × 20 cm (diameter) cyst was observed in the liver of the patient, and Echinococcus larvae were collected from the cyst. A morphological examination indicated that the larvae were E. ortleppi, and amplification and analysis of the nicotinamide adenine dinucleotide hydrogenase dehydrogenase subunit 1 (nad1) and cytochrome c oxidase subunit 1 (cox1) genes showed that the larvae had 99–100% homology with the corresponding E. ortleppi sequences on GenBank.

Conclusions

To our knowledge, this report describes the first identification of a human E. ortleppi infection in China. Our data broaden the geographical distribution of this rarely reported species of Echinococcus.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3653-y) contains supplementary material, which is available to authorized users.

Clinical review of liver hydatid disease and its unusual presentations in developing countries

Human hydatid cyst disease is an international public health issue that particularly affects the developing countries. In this article, we discuss the epidemiology of hydatid disease in third world countries, the life cycle of echinococcus granulosus and how to make the clinical diagnosis of the disease, including laboratory tests and imaging modalities as well as uncommon presentation of this entity that we have encountered at the American University of Beirut Medical Center (AUBMC). We emphasize on the new World Health Organization classification of hepatic echinococcosis with examples from our clinical practice at AUBMC, and finally we describe the treatment, including medical and interventional therapies.

Genotyping of Echinococcus granulosus Isolates from Human in Khorasan Province, North-Eastern Iran

BACKGROUND

Human hydatidosis is endemic in northeastern Iran. The present study aimed to investigate molecular diversity of Echinococcus granulosus isolates collected from human surgically.

METHODS

Sixty human hydatid cysts (58 lung cysts and 2 liver cysts) were collected through surgery from Ghaem and Emam Reza hospitals in Mashhad University of Medical Sciences during 2015-2016. Cysts were characterized using polymerase chain reaction-restriction fragment length polymorphism (PCRRFLP) analysis of the internal transcribed spacer 1 (ITS1) gene and sequencing fragments of the genes coding for mitochondrial cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit I (nad1).

RESULTS

Overall, 55 out of 60 Echinococcus granulosus cysts (91.6%) were determined as the G1 strain, 4 cases (6.6%) were determined as the G6 strain and 1 sample was not identified.

CONCLUSION

Although sheep strain (G1) is dominated in human patients in Great Khorasan, the prevention of camel-dog cycle should pay attention in this region.

Skeletal manifestations of hydatid cystic disease in Sudan

Objectives

Hydatid bone disease is a zoonotic disease caused mainly by Echinococcus granulosus. Middle Eastern, African, and Mediterranean populations are endemically affected. Hydatid disease of the bone is a rare clinical condition that affects people with a history of animal contact. This research aims to revisit clinical presentations of hydatid cystic disease in the skeletal system.

Methods

Data of all clinical cases with hydatid cystic disease of the skeletal system, presenting between 2011 and 2016 were collected. Clinical manifestations and radiographic and histopathological reports were reviewed, and the patients were followed for a period of 12-22 months.

Results

Two patients had hydatid disease in the spine, one in the pelvis, one in the sternum, and one in the femur. The symptoms were suggestive of pathological fractures and bony deformities. Spinal hydatid disease presented with nerve root compression and paraparesis in one case, and radicular pain in the other case. Sternal involvement of hydatid disease presented with pain and deformity, while femoral involvement presented with deformity and fracture. Surgical resection with a pre- and post-surgical anthelminthic course and application of the puncture, aspiration, injection, and aspiration (PAIR) technique were completed in four cases. One case showed residual disease during follow-up visits.

Conclusions

Hydatid cystic disease of the skeletal system is a rare presentation of a common disease. A multidisciplinary approach is optimal for the management of these cases. Long-term follow-up is mandatory to prevent complications and recurrence, and to monitor residual disabilities.

Primary pelvic hydatid cyst: A rare case presenting with obstructive uropathy

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Primary pelvic hydatid cysts are uncommon, usually presenting with pressure effects on the adjacent organs such as the urinary bladder and rectum.

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Combination of preoperative albendazole therapy, surgery and postoperative albendazole therapy is a useful regime.

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Familiarity with atypical manifestations of hydatid disease may be helpful in making a prompt and accurate diagnosis.

Introduction

Hydatid disease is caused by infection with larva of the cestode echinococcus. Humans are accidental intermediate hosts. Primary pelvic hydatid cyst is a rare entity.

Presentation of case

This is a case report of a 50 year old gentleman who presented to us as a case of suprapubic swelling and difficulty in micturition. General physical examination and radiological evaluation confirmed a multiloculated pelvic swelling. Patient was subjected to laparotomy which confirmed the diagnosis of a primary pelvic hydatid disease.

Discussion

Surgery is the optimal treatment of the pelvic hydatid disease. Radical resectional procedure or en bloc resection that removes the entire pericyst is the surgical technique of choice.

Conclusion

Familiarity with atypical manifestations of hydatid disease may be helpful in making a prompt and accurate diagnosis. Surgery is the treatment of choice.

Prevalence and characterization of hydatidosis in Najdi sheep slaughtered in Riyadh city, Saudi Arabia

Hydatidosis is considered to be one of the important zoonotic diseases and has a significant public health importance due to the difficulties of the diagnosis. Domestic animals act as intermediate hosts and the main reservoir for the disease in humans. The main purpose of this work therefore was to determine the prevalence of hydatidosis in Najdi sheep slaughtered in Riyadh city, Saudi Arabia. Cyst location and cyst fertility and viability were also estimated, together with effect of seasons, age and sex on the prevalence of the infection. The prevalence of hydatidosis was evaluated by post-mortem examination, with intensive inspection of the visceral organs of 2785 Najdi sheep. The infection was found to prevail throughout the year in both sex, with an overall prevalence of 2.33%. The highest prevalence was recorded in winter (6.48%) while the lowest was encountered in summer (1.36%). Females were proved to be more prone to infection (70.7%) than males (29.3%). In the present study, younger sheep tended to have a higher prevalence of infection than older ones. The most commonly infected organ was the liver, with a prevalence of 81.5%. The recorded cysts showed a fertility rate of 75.4%, and a high viability rate of 61.2%. Hepatic cysts were the most fertile and viable ones (46%), while calcified cysts were not recorded during the study. Measurements of recorded cysts in all organs ranged from 2 to 6 cm in diameter. In conclusion, the high fertility and viability rate of the recorded cysts suggest that sheep are a potential source of hydatidosis transmission to dogs and the continuation of its life cycle in this region. Consequently, authorities are recommended to instigate stricter regulation of the slaughtering process, including the secure disposal of infected offal so as to minimise the transmission of cysts from slaughter houses, along with treatment of stray dogs.

Excision of innumerable hydatid cysts from the myocardium of the left ventricle via the left thoracotomy along with myoplasty on beating heart

Cardiac hydatid cyst is a rare disease with frequency of less than 2%. The left ventricle is the most common site. Symptoms depend upon site of involvement ranging from asymptomatic to acute coronary syndrome, arrhythmias, valvular lesions, etc. It is a surgical emergency, therefore early diagnosis and surgical treatment is required even in asymptomatic patients. Surgical excision on beating heart along with preparedness with cardiopulmonary bypass and fibrillator via left anterolateral thoracotomy can be done successfully, followed by medical treatment with albendazole. Increased awareness and high degree of suspicion among cardiac physicians in the endemic area is essential for early diagnosis. Echocardiography remains the gold standard for diagnosis and follow-up of patient.

Hydatid cyst of the thigh: A case report with literature review

INTRODUCTION

Hydatid diseases are cystic parasitic infestation caused by Echinococci. The most frequently affected organs are liver and lung. The aim of this study is to report a rare case of hydatid disease of the thigh.

PRESENTATION OF CASE

A 34-year-old female presented with mild, continuous lower abdominal pain. Concomitantly, she was complaining of gradually increasing swelling of the left thigh for about 9 month duration. On examination, there was tender, 3 × 4 cm, suprapubic mass with firm non-tender 10 × 17 cm swelling at the lateral aspect of left thigh. Magnetic resonance imaging confirmed the diagnosis thigh hydatid cyst. It was managed by surgical resection.

DISCUSSION

In endemic regions, hydatidosis can be controlled by several preventive mechanisms including regular medication of definitive hosts by praziquantel, vaccinating sheep, preventing dog's access to intermediate hosts, boiling or safe disposal of offal. The current case reported positive history of animal contact without fulfilling any preventive measure.

CONCLUSION

Hydatid cyst of the thigh is a very rare parasitic manifestation presenting as a painless swelling, diagnosed typically by MRI and managed with en bloc resection.

Imaging in pulmonary hydatid cysts

Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored.

Epidemiological and clinical aspects of patients with hydatid cyst in Iran

Hydatid cyst is one of the most common Zoonotic diseases occurs due to infection with larval stage of Echinococcus granulosus parasite. Based on epidemiological reasons, World Health Organization has introduced Iran as a hyperendemic region. This study aims to investigate the clinico-epidemiological characteristics of patients with hydatid cyst in Iran. We used information registered in the surveillance system of the Iranian Ministry of Health and Medical Education attributed to Mazandaran province. Data were entered into SPSS software V.20 after refinement and analyzed using percent frequency, mean, standard deviation and statistical tests such as Chi-square and Exact Fisher tests. Mean (SD), minimum and maximum ages of the participants were 42.2 (17.2), 6 and 72 years respectively. Most of them were female (63.4 %) and mean (SD) number of cysts was 1.6 ± 0.8. Of them, 51.2 % living in rural areas and 58.5 % of them were housewives. Liver was the most common organ involved. The main diagnostic procedures were radiography and CT scanning. The majority of participants (73.2 %) consumed unsterilized vegetables. This study showed women more susceptible compared to men probably because of more exposure to parasites through vegetables. We also found the liver as the most affected organ in hydatid cyst patients.

Isolated renal hydatid presenting as a complex renal lesion followed by spontaneous hydatiduria

Echinococcosis is a zoonotic disease. Liver is the most common site of involvement. Renal involvement is seen in 2% to 3% of patients. Computed tomography findings in renal hydatid typically include: a cyst with thick or calcified wall, unilocular cyst with detached membrane, a multiloculated cyst with mixed internal density and daughter cysts with lower density than maternal matrix. Rarely type IV hydatid cysts may mimic hypovascular renal cell carcinoma. We report a case of previously asymptomatic middle aged female who presented with mild intermittent pain and a complex renal lesion on imaging which was considered to be a hypovascular renal carcinoma or urothelial neoplasm. However, by serendipity, the patient had spontaneous hydatiduria and later was definitively diagnosed and stented. Hydatid disease should always be considered amongst the top differential diagnosis of an isolated “complex” renal lesion which remains indeterminate on imaging.

Primary retroperitoneal hydatid cyst: a rare case report

Hydatid disease is a parasitic tapeworm infestation that usually involves liver and lungs. Primary retroperitoneal hydatid without liver and lung involvement is very rare. Surgery is the principle method of treatment for large retroperitoneal hydatid, whenever feasible. We report a case of primary retroperitoneal hydatid cyst in 29-year-old male patient.

Traumatic rupture of a solitary splenic hydatid cyst: A case report

The rupture of an Echinococcus granulosus hydatid cyst in the spleen due to trauma is a rare event. In this case report we describe the case of a 39-year-old Lebanese male victim of a motor vehicle accident with a ruptured solitary splenic hydatid cyst discovered by CT scan and excised during exploratory laparotomy.

Echinococcosis or hydatid disease is a parasitic infestation by the Echinococcus genus of tapeworm. The eggs of E. granulosus, a species of Echinococcus, are fecal-orally transmitted to human hosts, most often from dog feces, and manifest as cystic lesions termed hydatid. E. granulosus most commonly affects the liver (75%), lungs (15%), and rarely the spleen (2–5%) [1], [2]. E. granulosus is particularly endemic to cattle rearing areas of the Middle East. Infected patients most commonly present with vague abdominal pain, as a result of mass effect or spontaneous rupture of the cyst. Nevertheless, patient presentation may be due to traumatic rupture of a hydatid cyst; however, this is very rare. Herein we report a case of traumatic rupture of a solitary splenic hydatid cyst in a 39-year-old male following a motor vehicle crash, managed following the Advanced Trauma Life Support (ATLS) protocol.

Primary intraosseous hydatid cyst of femur

Introduction:

Echinococcosis is a parasitic and zoonotic disease of animals and humans. The cause is Echinococcus granulosus and occasionally, Echinococcus multilocularis. Hydatid cysts are mostly seen in the liver and lungs, although almost all organs and systemscan be involvement. Hydatid cysts seen with bone involvement comprise approximately 3% of all hydatid cysts. Even if a long period of survey is possible, it is still difficult to eradicate the disease and effect a cure.

Case Presentation:

In this study, an evaluation was made of a patient referred at Yozgat State Hospital Orthopedics and Traumatology Polyclinic with complaints of pain in her left thigh close to the knee. After examinations of plain radiographs, computerized tomography, magnetic resonance images, and blood parameters, a diagnosis was made of left femoral intramedullary hydatid cyst from excised intraoperative material. Throughout a 6-month follow-up period, there was no recurrence and functional results were good.

Conclusions:

Based on this report (of a patient presented with an intramedullary cyst in the long bones), the primary bone hydatid cyst disease should be kept in mind and be investigated in the differential diagnosis.

Review of the treatment of liver hydatid cysts

A review was carried out in Medline, LILACS and the Cochrane Library. Our database search strategy included the following terms: “hydatid cyst”, “liver”, “management”, “meta-analysis” and “randomized controlled trial”. No language limits were used in the literature search. The latest electronic search date was the 7^th of January 2014. Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis. Information from editorials, letters to publishers, low quality review articles and studies done on animals were excluded from analysis. Additionally, well-structured abstracts from relevant articles were selected and accepted for analysis. Standardized forms were designed for data extraction; two investigators entered the data on patient demographics, methodology, recurrence of HC, mean cyst size and number of cysts per group. Four hundred and fourteen articles were identified using the previously described search strategy. After applying the inclusion and exclusion criteria detailed above, 57 articles were selected for final analysis: one meta-analysis, 9 randomized clinical trials, 5 non-randomized comparative prospective studies, 7 non-comparative prospective studies, and 34 retrospective studies (12 comparative and 22 non-comparative). Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts. More studies in the literature support the effectiveness of radical treatment compared with conservative treatment. Conservative surgery with omentoplasty is effective in preventing postoperative complications. A laparoscopic approach is safe in some situations. Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver. Radical surgery with pre- and post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.

Surgical treatment of hepatic echinococcosis in Prizren (Kosovo)

Management option of hepatic echinococcosis represents a major challenge for a surgeon. The aim of the study was to evaluate surgical treatment of patients with hepatic echinococcosis at the surgery department of the regional hospital in Prizren (Kosovo). The medical records of 22 patients operated for hepatic echinococcosis in our department during a four year study period (2009–2013) were retrospectively reviewed. Apart from the total of 5850 operated patients, 22 cases were diagnosed for liver echinococcosis (0.4%). The most affected age group was from 26 to 50 years (54.5%). Female gender, 16 cases (73%), and patients living in rural places, 14 patients (64%), dominated significantly. The most affected region was Municipality of Dragash. All patients underwent ultrasonography, 13 patients underwent CT scans and 5 patients MRI of abdomen. The mean preoperative ultrasonographic diameter of cysts was 9.5 cm and maximal 21 cm. Cysts were most often localized in right hepatic lobe (77%) and subcostal laparotomy was most commonly performed (82%). The performed surgical procedures were: endocystectomy and partial pericystectomy with omentoplication according to Papadimitris (73%), endocystectomy and capitonnage and endocystectomy with external drainage (14%). The laparoscopic approach was used only in one patient. In conclusion, hepatic echinococosis was not common among operated patients at our surgery department. Subcostal laparotomy with endocystectomy and partial pericystectomy with omentoplication according to Papadimitris was most commonly used. Exact distribution of echinococcosis is needed to be analyzed with a larger cohort study including all surgery units in the country and with a longer monitoring.

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We evaluated patients with hepatic echinococcosis at the regional hospital.

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Hepatic echinococosis was not common at our surgery department.

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Subcostal laparotomy with endocystectomy was most commonly used.

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A stage-specific approach is recommended.

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True distribution of echinococcosis should be analyzed with a larger cohort study.

Primary subcutaneous inguinal hydatid cyst: diagnosis by fine needle aspiration cytology

Hydatid disease or human cystic echinococcosis, recognized by ancient scholars such as Hippocrates, Galen and Rhazes, is one of the oldest diseases known to man. Though hydatid cyst may develop in almost any part of the body, a solitary primary subcutaneous localization is an extremely rare entity. We herein report a case of primary subcutaneous inguinal hydatid cyst which was diagnosed by fine needle aspiration cytology. Radiological examination done subsequently corroborated with the cytodiagnosis of Hydatid cyst and did not show involvement of any other organ or site. Histopathological examination of surgically removed cyst confirmed the diagnosis of Hydatid cyst. Hydatid disease should be considered in the differential diagnosis of all unusual swellings in soft tissues, especially in regions where the disease is endemic.

Incidentally detected cardiac cyst hydatid after blunt thoracic trauma

Cardiac involvement in hydatid disease is more seldom than the involvement of the liver and the lungs. Cardiac cyst hydatid disease is diagnosed incidentally or by means of symptoms such as dyspnea and angina pectoris. Here, we present the case of a 45-year-old male patient who underwent open heart surgery for a randomly detected cardiac cyst hydatid during investigations carried out in a healthcare institution after accidentally falling from height. On the other hand, this patient did not have any complaints associated with hydatid disease before this event.

Hydatid disease of spine: Multiple meticulous surgeries and a long term followup

We present a long term followup (13 years) of spinal hydatid disease with multiple recurrences and intradural dissemination of the disease at the last followup. Intradural extension of the disease in our case was supposedly through the dural rent which has not been reported in English literature. An early followup of the same case has been reported previously by the authors. A 53 year-old female came with progressive left leg pain and difficulty in walking since 2 months. On examination, she had grade four power of ankle and digit dorsiflexors (L4 and L5 myotomes) on the left side (Medical Research Council grade). There was no sensory loss, no myelopathy and sphincters were intact. Plain radiographs showed consolidation at D10-D11 (old operated levels) with stable anterior column and there were no implant related problems. Magnetic resonance imaging showed a cystic lesion at L3-L4, signal intensity same as of cerebrospinal fluid in T2 and T1, displacing the cauda equina roots. The proximal extent of the lesion could not be identified because of artifacts from previous stainless steel instrumentation. Computed tomography myelogram showed complete block at L3-L4 junction with "meniscus sign". This is the longest followup of hydatid disease of the spine that has ever been reported. Hydatid disease should always be included in the differential diagnosis of destructive or infectious lesions of the spine. Aggressive radical resection whenever possible and chemotherapy is the key to good results. Recurrence is known to occur even after that. Disease can have long remission periods. Possibility of intradural dissemination through dural injury is highly likely. Hence, it should always be repaired whenever possible.

Supratentorial neurenteric cyst mimicking hydatid cyst: A case report and literature review

Neurenteric (NE) cysts are uncommon congenital cysts of endodermal origin. These cysts are commonly encountered in the posterior fossa surrounding the brain stem structures. We present a case of pathologically proven supratentorial NE cyst that mimicked a hydatid cyst in its clinical presentation and imaging appearance. Including this pathology in the differential diagnosis of supratentorial cystic lesions is important due to the differences in medical and surgical management.

Hydatid disease in childhood: revisited report of an interesting case

Hydatid disease is a zoonosis caused by the tapeworm of Echinococcus spp. The disease is widely endemic in many sheep and cattle rearing locales. However, hydatidosis does not remain restricted to endemic geographical locales anymore but rather is a global health concern. It is a major public health burden causing significant morbidity and mortality. Echinococcus granulosus involvement in children has a different pattern than adults. Children of all age groups are susceptible and localization of the disease in the lungs is more commonly seen. Multiple liver cysts in the paediatric age group is relatively uncommon. We report an interesting case of multiple liver cysts in a 5-year old boy which was diagnosed as hydatid cysts on histopathological examination.

Canadian-acquired hydatid disease: A case report

Echinococcal cysts are unusual in Canada, and most cases seen are in immigrants. In northern Canadian communities, Echinococcus granulosis infection occasionally is acquired from dogs that feed on the entrails of caribou or moose. Seventeen patients with Canadian-acquired hydatid cysts were seen over an 11-year period. One challenging case is described in detail. An 18-year-old aboriginal woman presented with jaundice, pain, lower extremity edema and coagulopathy from a 26 cm echinococcal hepatic cyst. She was successfully treated with a combination of oral albendazole, percutaneous drainage and surgery. One-year follow-up showed no recurrence of disease. The management options for echinococcal cysts are extensively reviewed.

Primary hydatid cyst of kidney and ureter with gross hydatiduria: A case report and evaluation of radiological features

We report a rare case of echinococcosis, primarily involving the right kidney and ureter, presenting with gross hydatiduria. We also present the salient diagnostic features of renal hydatid.

Ovarian hydatid cyst: A case report

Discovering an hydatid cyst in pelvic region, especially as primary localization, is a rare event; as a matter of fact according to data provided by literature the incidence is between 0.2 and 2.25%. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. When possible the optimal treatment is represented by radical laparotomic cystectomy. We report a case of an old woman affected by this pathology that we have treated with a cyst's marsupialization after a draining and irrigation of cyst cavity with hypertonic saline solutions.

Concomitant Rupture of Hydatid Cyst of Liver in Hepatic Duct and Gallbladder: Case Report

Hydatid cyst liver rupture into the biliary tree may involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts or rarely the gallbladder. Rupture can be occult or frank. A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event. The authors are reporting a case of concomitant rupture of hydatid cyst of liver into right hepatic duct and the gallbladder. A 50-year-old female patient who presented with acute cholangitis was confirmed as a case of intrabilary rupture on ultrasonography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. Rupture of hydatid cyst of liver in right hepatic and the gallbladder was confirmed on surgery. Suture repair of cystobiliary fistula, choledochoduodenostomy with cholecystectomy was done.

Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease

The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.