Hepatic Hydatid cyst with rupture

Hepatic Hydatid cyst with rupture

Adult female patient with abdominal pain

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case-image
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Observation and interpretation

CECT Upper abdomen:

  • Well-defined, rounded hypodense cystic lesion in right lobe of liver. Multiple collapsed thin membranes are seen within it (yellow arrows).
  • Loculated collection in perihepatic region and involving the right abdominal wall. It is communicating with the above cystic lesion (white arrow).
case-image
case-image

Principal Diagnosis

Ruptured hepatic hydatid cyst

Differential Diagnosis

NONE! This is an Aunt Minnie.

Further Management

  • Urgently inform the referring clinician and refer to surgical team on call.
  • Urgent surgical intervention is the mainstay of treatment  – removal of cyst membrane and closure of tract.
  • Supplementary treatment with anti-helminthic drugs.

Teaching Points

  • Hydatid disease is caused by the parasitic infection of Echinococcus.
  • Echinococcus is a tapeworm found in dogs (definitive host), pigs (intermediate host), sheep, goats and cattle. Humans are accidental hosts. Infection occurs by ingestion of food which is contaminated by Echinococcus eggs.
  • Liver is the most involved organ followed by lungs and spleen. Cerebral and spinal hydatid cysts have also been reported.
  • Cyst wall is made up of 3 layers, namely:
    • pericyst
    • exocyst
    • endocyst.
  • Calcified hydatid cysts can be seen as rounded opacities on radiographs.
  • PAIR procedure (Puncture, Aspiration, Injection and Re-aspiration) is usually performed for treatment of un-ruptured hydatid cyst.

References

  1. Pedrosa, I., Saíz, A., Arrazola, J., Ferreirós, J., & Pedrosa, C. S. (2000). Hydatid Disease: Radiologic and Pathologic Features and Complications. RadioGraphics, 20(3), 795–817. doi:10.1148/radiographics.20.3.g00ma06795 (https://doi.org/10.1148/radiographics.20.3.g00ma06795)
  2. Kantarci M, Bayraktutan U, Karabulut N et al. Alveolar Echinococcosis: Spectrum of Findings at Cross-Sectional Imaging. Radiographics. 2012;32(7):2053-70. doi:10.1148/rg.327125708Pubmed
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