A rare presentation of hydatid cyst in a child

Cyst hydatid is the most widespread, serious cestode infection in the world. The most common organ affected by hydatid disease is the liver followed by the lungs and the two organs are affected simultaneously in about 5-13% of cases. The involvement of kidneys are rarely reported. Here we reported a patient with hydatid cysts in lung and kidney which the surgery was effective for both organs. The rarity of this case is the unusual combination of the cyst development in these organs without the involvement of liver.     

Anaemia in Waldmann's disease: A rare presentation of a rare disease

A 32-year-old female presented with 5-year history of iron deficiency anemia, marked pallor and edema of both lower limbs. Laboratory investigations including complete blood count, blood film, iron studies, lipid profile, ascitic fluid analysis, test of stool for occult blood and alpha 1 anti-trypsin. Upper, lower gastrointestinal(GIT) endoscopies, and enteroscopy were performed. Imaging techniques as abdominal ultrasonography and computed tomography were done. Echocardiography, lymph node biopsy and bone marrow examination were normal. The case was diagnosed as Waldmann's disease with protein losing enteropathy and recurrent GIT bleeding. Management started with low fat diet with medium chain triglyceride, octreotide 200 μg twice a day, tranexamic acid and blood transfusion. Then, exploratory laparotomy with pathological examination of resected segment was done when recurrent GIT bleeding occurred and to excluded malignant transformation.     

Endocardial hydatid cyst: a rare presentation of echinococcal infection

A previously well 45-year-old male presented with 20 days ofbeing generally unwell with a fever and dyspnoea on exertion.Transthoracic echocardiography was done and revealed a roundcystic structure (3x3 cm) attached to the tricuspid valve. Multiplesmall calcified particles (daughter cysts) were also seen inthe cyst which was most consistent with the diagnosis of Hydatidcyst. The serology for Echinococcus granulosus antibody waspositive and confirmed the diagnosis. The patient was sent forcardiac surgery and hydatid cyst which was endocardial in location,and adherent to the tricuspid valve leaflets was the intraoperativefinding. The patient improved and was discharged on long-termchemotherapy. The most common cite of cardiac involvement isthe myocardium followed by the pericardium, whereas endocardialinvolvement is extremely rare. In the present study, we demonstrateda very rare case of endocardial hydatid cyst with attachmentto the tricuspid valve.     

Mediastinal hydatid disease: an unusual presentation

Hydatid disease is a significant health problem in endemic areas. While occurrence of the cysts in the liver and lung is common, mediastinal localisation is extremely rare. We report the case of a 35-year-old male who presented with a painless swelling on the right side of the neck and features of superior vena caval obstruction. Chest radiography and computed tomography (CT) suggested a cyst in the right upper lobe, extending into the right supraclavicular region as well as another cyst in the left lung. Thoracotomy revealed that the right-sided cyst was actually mediastinal in location and had herniated through the thoracic inlet compressing the superior vena cava (SVC). Both cysts were removed in two separate operations and symptoms of SVC compression subsided after removal of the right-sided cyst. Histopathology was consistent with a hydatid disease.     

Whipple's disease with constrictive pericarditis: A rare disease with a rare presentation

Whipple’s disease is a multisystem disease that can affect the heart with predominantly endocardial and pericardial involvement and, less often, myocardial inflammation. Previously diagnosed at autopsy, cardiac involvement in Whipple’s disease is being recognized clinically more often. A 58-year-old man with Whipple’s-related constrictive pericarditis, arthralgias and lymphadenopathy is described. He underwent antibiotic treatment and pericardiectomy with improvement in his clinical state.     

Nocardia liver abscess post liver transplantation—A rare presentation

Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long‐term antibiotics for Nocardia infection.     

A rational approach to the terminology of hydatid disease of the liver.

Hydatid disease is one of the most important global health problems. Areas of progress in its management, however, remain unclear due to the incomplete, confusing and conflicting terms which have been used to describe it. To avoid this confusion it is proposed that the management of hydatid disease of the liver should be classified as follows. The hydatid cyst may be described as univesicular, multivesicular or secondary abdominal implantation. The surgical treatment of the cyst may be adequately described as either evacuation, enucleation, pericystectomy or hepatectomy and the method of treating the residual cavity in the liver following surgery as leaving open, suture-closure, closed tube drainage or marsupialisation. This classification is felt to be comprehensive and its application may avoid the confusion which is currently present in the literature on hydatid disease of the liver.     

Breast lump as a presentation of a hydatid disease

Hydatid disease is a lesion caused by larval form of Echinococcus granulosus and is seen endemically in sheep-rearing countries. Humans are intermediate hosts of this organism. The liver is the first filter that stops about 75% of the embryos and the lungs filter another 10%, leaving only 15% to develop into cysts in other organs of the body.     

Eosinophilic vasculitis: a rare presentation of Whipple's disease.

Whipple's disease is a multisystem infectious disease caused by the bacterium Tropheryma whippelii. A case with an unusual presentation is reported. A 66-year-old man presented with a febrile vasculitic rash on his forearms. An extensive rheumatological, hematological and infectious workup gave negative results, apart from mild anemia and eosinophilia. An abdominal computed tomography revealed a retroperitoneal lymphadenopathy, and a skin biopsy revealed an eosinophilic vasculitis. This diverted the work toward ruling out a lymphoma or a vasculitic process. A lymph node biopsy was then performed and showed a diffuse neutrophilic inflammation with abundant foamy macrophages, fat necrosis and lipogranuloma formation. These findings were considered to be nonspecific and no further pathological investigation was carried out. After a course of corticosteroids, diarrhea and weight loss predominated and subsequently a diagnosis of Whipple's disease was confirmed on a small-bowel biopsy. Lymph node involvement was then confirmed on re-evaluation using the appropriate stains.     

Adult polyglucosan body disease: a rare presentation with chronic liver disease and ground-glass hepatocellular inclusions

Liver involvement in genetic and metabolic disorders may result in intrahepatic accumulation of specific precursors or byproducts, which have distinctive features on light microscopy. The "polyglucosan disorders" are diseases in which polyglucosan (abnormal glycogen with decreased branching) is formed and deposited in various tissues because of decreased or absent glycogen branching enzyme activity. These disorders include Lafora disease (myoclonus epilepsy) and type IV glycogen storage disease. Polyglucosan deposits in both conditions result in ground-glass hepatocellular inclusions resembling those seen in chronic hepatitis B virus infection. In the present report, we describe a case of the rare, adulthood form of glycogen branching enzyme deficiency, adult polyglucosan body disease (APBD), in which abnormal serum liver tests prompted a liver biopsy. The pathologic findings of periportal ground-glass hepatocellular inclusions, mild chronic portal inflammation, and periportal fibrosis are not well described in APBD, but resemble the chronic changes that have been reported in Lafora disease. The differential diagnosis of ground-glass hepatocytes and the genetic basis of APBD are discussed.     

Jaundice caused by hydatid disease of the liver

Between 1980 and 1985, 40 patients were treated surgically for hydatid disease of the liver. In 4 cases (10%) jaundice was the first and most conspicuous sign of this disease. The patients originated from Spain, Morocco, Turkey and Lebanon. In 2 of these cases the initial diagnosis was hepatitis; one patient was operated on for suspected acute cholecystitis. All 4 patients had an eosinophilia and positive hydatid serology. Hydatid material was found in the biliary tract in two cases, while bile-stained hydatid fluid proved that there was a communication between cystic cavity and biliary tract in the other two patients. Obstruction of the common bile duct by hydatid elements causes jaundice and probably also cholangitis. Calcifications in the cyst are no guarantee against future complications. Surgery is the treatment of choice. When patients from an endemic area present with jaundice, hydatid disease of the liver should be suspected, particularly if eosinophilia also exists.     

Rim calcification in primary liver cell carcinoma mimicking hydatid disease.

The case described is of a primary liver cell carcinoma (PLCC), which was initially misdiagnosed as hepatic hydatid disease. The computed tomographic appearances of hepatic hydatid disease are often characteristic although not specific. When supported by the clinical findings, however, they will probably not be confused with other liver masses. In this case the presence of peripheral rim calcification, commonly seen in hydatid disease but which has not been previously noted in PLCC, lead to an erroneous diagnosis.