Hydatid disease of spleen treated by cyst enucleation and splenic salvage

A 4-year-old boy with unilocular hydatid cysts of spleen and liver was successfully treated by enucleation of both the cysts and salvage of the spleen. The conventional surgical treatment of choice for hydatid cyst of the spleen is splenectomy. The authors demonstrate that preservation of a spleen afflicted by hydatid disease is technically feasible and is recommended as the choice of treatment to obviate the well-recognized postsplenectomy complications especially in children.     

Primary hydatid cyst of adrenal gland. Report of two cases

Primary hydatid cyst of adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in our country in which echinococcal disease is endemic. We report two cases of primary hydatid cyst of adrenal gland presented with isolated abdominal pain. The diagnosis was based on CT-scan, which showed a cystic mass of respectively the right and left adrenal gland with a calcified wall. The echinococcal immunologic test (Elisa) was positive in one case. The surgical treatment consisted on a total resection of the cyst, without rupture of the cystic wall and preserving the gland. The diagnosis was confirmed on the macroscopic examination of the resected pieces. In the first case the cyst was multilocular filled with daughter cysts and in the second case the cyst was unilocular filled with hydatid membrane and clear fluid. In the two cases, the postoperative course was uneventful. No recurrence had occurred respectively after 24 months and 36 months of follow up.     

Evacuation of hydatid liver cysts using laparoscopic trocar

Several methods of reducing the likelihood of spilling live scolices during surgical removal of hydatid liver disease have been described. The aim was to determine the effectiveness and safety of laparoscopic trocar insertion for evacuation of hydatid liver cysts. This technique was used for 30 cysts in 19 patients who had surgery for hydatid liver disease. After establishing protection of the operative area, a laparoscopic trocar was inserted into the cyst at the most prominent point and the cyst was aspirated with large-bore suction and filled with a scolicidal agent. The technique was not attempted in two small cysts (<6 cm) located near the major blood vessels or in a single intraparenchymal cyst. Insertion of the trocar was successful in all remaining cysts, and there were no complications during the insertion or the evacuation. Successful evacuation (excellent and good outcomes) in unilocular, multilocular, and degenerated cysts were 100%, 84%, and 57%, respectively (p = 0.144), with a total success rate of 82%. Although successful evacuation was achieved in both anterior (92%) and posterior-superior located cysts (73%) (p = 0.203), excellent outcomes were higher for the anterior cysts (73%) than for the posterior-superior cysts (13%) (p = 0.005). Successful evacuation outcomes for the large (> 10 cm), middle-sized (6 to 10 cm), and small cysts (<6 cm) were 100%, 79%, and 67%, respectively (p = 0.591). The patients have been followed for a mean of 11 months (range 3 to 24 months), and no recurrence has been recorded. Insertion and evacuation of the hydatid liver cysts with a laparoscopic trocar is a safe and effective procedure, and its limitations are minimal.     

Isolated unilocular renal hydatid cyst: a rare diagnostic difficulty with simple cyst

Hydatid disease is endemic in many parts of the world. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% of the cysts occur in the rest of the body. It may develop in almost any part of the body. Although hydatidosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except for eosinophilia which is found in only 50% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain radiography or intravenous urography, and ultrasound or computed tomography cannot always show a hydatidosis as a specific lesion. From these reasons, sometimes it is difficult to differentiate between a unilocular hydatid cyst without mural calcification and a simple renal cyst. So, despite its rarity, hydatid disease should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We present herein a patient with isolated renal hydatid cyst mimicking a simple cyst treated successfully with complete excision.     

肝包虫病的CT诊断及介入治疗

目的分析肝包虫病的CT表现,探讨不同类型肝包虫病临床治疗价值。方法回顾分析36例经CT诊断及手术病理证实的肝包虫病影像资料。结果36例共发现肝包虫囊肿42个。其中单房型包虫囊肿18个,其CT表现为边缘光滑的圆形或类圆形囊性低密度灶,囊壁厚薄均匀。多房型包虫囊肿24个,包虫囊肿内可见多个子囊和不同密度的内容物,整个囊肿形态呈车轮状。实质钙化型包虫囊肿9个,表现囊内容物不同程度钙化。囊壁钙化17个,囊壁轻度至中度强化。CT在术前诊断准确率为94.4%。共15个囊肿(13个单房型,2个多房型)进行CT引导下经皮抽吸注入酒精治疗,经复查疗效肯定。结论CT对各种类型肝包虫囊肿具有较高诊断价值,而且对于单囊型包虫囊肿CT引导下介入治疗效果肯定,可达到手术切除的效果。     

The radical treatment of hepatic hydatidosis with deep and multiple locations. The role of new technologies particularly in the case of multiple locations

Advanced technologies (intraoperative ultrasonography, CT scan, argon coagulator ...) have changed the surgical approach of liver hydatid disease, allowing even multiple or deeply located cysts to be detected and treated successfully. Authors report a series of 4 patients with single (3) or multiple (1) unilocular hepatic cysts; and 1 patient with thoraco-pulmonary hydatid recurrent disease. Treatments of choice and surgical techniques are described. No infective compliances occurred. The mean period of hospitalization was 19 days (ranging between 10 days and 4 weeks). The longest hospitalization was observed in a patient with a post-operative biliary fistula at low out put. Total cysto-pericystectomy is emphasized as the gold standard procedure in the treatment of non complicated unilocular hydatid cysts of the liver. Modern means of investigation and technical equipment make it feasible and safe even in unfavorable localizations, allowing radical removal of the cysts preserving in the meantime all the surrounding liver parenchyma.     

Effect of albendazole on human hydatid cysts: an ultrastructural study

Five patients with hepatic (3), pelvic (1) or spinal (1) hydatid cysts received 10 mg/kg/d albendazole for 1-3 months prior to surgery. Daughter cysts were present in the spinal hydatid and in one patient with hepatic disease. Electron microscope examination of the cyst tissue of the pelvic and the 2 hepatic cysts lacking daughter cysts showed no evidence of germinal layer, and the protoscoleces were dead. The primary cyst of the hepatic hydatid with daughter cysts (1 month therapy) was also judged dead but some pieces of the daughter cyst germinal layer appeared normal and had unaffected protoscoleces. The daughter cyst tissue of the spinal hydatid (3 month therapy) appeared normal and the protoscoleces viable. In view of the undetermined viability of human hydatids before chemotherapy, treatment of longer than 1 month is advocated for hepatic cysts, particularly if daughter cysts are present, and longer therapy is indicated for spinal disease.     

Laparoscopic management of an isolated primary omental hydatid cyst: A case report and literature review

Primary isolated omental hydatid cysts are extremely rare. Usually, omental hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, we report a case of a primary isolated omental hydatid cyst treated with a laparoscopic approach.We report a 16-year-old female who admitted to hospital with right upper quadrant pain. Abdominal ultrasonography and computed tomography (CT) revealed a cyst located between the liver and right kidney. The cyst was enucleated from the omentum and removed with a laparoscopic approach. Histopathologic examination revealed a hydatid cyst. There was no recurrence during 3 years of follow-up. Primary isolated omental hydatid disease should be considered in patients in endemic regions with intra-abdominal cysts. Laparoscopic surgery seems to be effective and safe for hydatid cysts in accessible locations.     

An unusual cause of mass in the shoulder: A primary hydatid cyst

A hydatid cyst is a zoonotic infection which may affect any organ and tissue, particularly the liver and the lung. Primary muscular hydatid cysts comprise less than 0.7-3% of the cases. The hydatid cysts must be kept in mind to avoid a diagnostic puncture in cystic lesions to avoid the spreading of the disease. In this case report, we present an exceptionally rare case with an unusual localization of a primary hydatid cyst in the left deltoid muscle.     

Hydatid cyst of the breast

Cystic hydatid disease is caused by the Echinococcus granulosus parasite. Most frequently, cysts develop in liver and lung. The breast is rarely a primary site of the hydatid cyst. A case of hydatid cyst of the breast is presented, the diagnosis of which was missed both pre-operatively and intra-operatively.     

Primary multiple cerebral hydatid cysts with unusual features

Summary We present a case of 45 years old female patient with two primary cerebral hydatid cysts, each localised in separate hemispheres. Detailed studies revealed no evidence of hydatid disease elsewhere in the body. The cysts were removed by two separate operations. Though the cyst in the right posterior parietal lobe was delivered unruptured, seven months later a new cyst was detected in the same cavity, which seems to show relatively rapid growth in a year, and was also removed unruptured.This case is presented here for its unusual features such as having two primary cerebral hydatid cysts simultaneously in separate hemispheres, one of which partly localised intraventricularly, and the occurrence of a new cyst in the same cavity following intact removal of the previous cyst.     

Intradural extramedullary primary hydatid cyst of the spine in a child: a very rare presentation

Spinal hydatid cyst is a serious but fortunately uncommon manifestation of the parasite Echinococcus, involving less than 1% patients with hydatid disease. Intradural hydatid cysts are extremely rare compared to other types of spinal hydatid cysts. We report a rare case of intradural, extramedullary spinal hydatid cyst in a 9-year-old male boy, who presented with weakness of both lower limbs for the last 4 months that was confirmed histopathologically; a better understanding of this rare but clinically challenging disease is intended by reporting this case.     

Hydatid Cyst of the Breast

Cystic hydatid disease is caused by the Echinococcus granulosus parasite. Most frequently, cysts develop in liver and lung. The breast is rarely a primary site of the hydatid cyst. A case of hydatid cyst of the breast is presented, the diagnosis of which was missed both pre-operatively and intra-operatively.     

Surgical treatment of hydatid cysts of the heart: a report of 3 cases and a review of the literature

Because the clinical signs and symptoms of cardiac hydatid cyst are nonspecific and highly variable, this disease may be difficult to diagnose. In this report, the cases of 3 patients with cardiac hydatid cysts located in the subepicardium are presented.In 2 of the patients the diagnosis was erroneous, and they were operated on for pulmonary hydatid cyst and acute abdomen in provincial hospitals before transfer to our institution. One patient who had an intrapericardially ruptured cardiac hydatid cyst presented with the clinical features of an acute abdomen. A patient with 4 subepicardial cysts had undergone surgery for a cardiac hydatid cyst 10 years before presenting at our hospital. The perforated cyst in this patient was excised while the heart was beating; the 2 other patients were operated on with extracorporeal circulation.The epidemiologic and pathologic features, clinical presentation, complications, diagnostic methods and treatment of cardiac hydatid cyst are discussed in detail in the light of pertinent literature.     

Uncommon abdominal sites of hydatid disease. Our experience with the surgical treatment of 15 cases

The aim of this retrospective study is to report on a series of 15 patients with abdominal hydatid disease in uncommon sites submitted to surgery in our unit over the period 1974-2003. Eight women and 7 men (mean age: 48.4 years) were included in the study. The hydatid cysts were located in the peritoneum in 8 patients, in the spleen in 5, in the kidney in 1 and in the retroperitoneum in 1. In 4 cases the peritoneal cysts were solitary, while 4 patients in this subgroup presented multiple cysts and 2 had concomitant liver hydatidosis. The splenic cysts were solitary in 2 cases, associated with a hepatic cyst in 2 and with a lung cyst in 1. The renal and retroperitoneal cysts were both solitary. The diagnosis was made at operation in 3 cases, while in 12 patients it was made by serological tests, ultrasonography and/or CT. All patients were operated on: we performed a total cystectomy in 7 patients with peritoneal cysts and in the patient with a retroperitoneal location, splenectomy in the 5 splenic cysts and a partial cystectomy with external drainage of the residual cavity in 1 peritoneal cyst and in the renal location. The postoperative course was regular with no mortality and no major morbidity in 14 patients, while 1 patient submitted to splenectomy developed a subphrenic abscess that required surgical drainage. Two recurrences occurred in patients with peritoneal cysts 71 and 20 months, respectively, after the first operation and these were managed by total cystectomy. The diagnosis of uncommon abdominal sites of hydatid disease is more accurate today because of the new imaging techniques, which are often able to show specific radiological signs of hydatid disease. The treatment of choice is surgical and complete removal of the cyst is the gold standard, but its feasibility is related to the location of the cyst.     

Interventricular hydatid cyst imitating pulmonary stenosis

Cardiac hydatid cyst is known to be a rarely occurring disease. The appearance of large cysts in the interventricular septum in childhood is even more rare. Although such cysts are usually asymptomatic, they can behave like valvular disorders, depending on their location. In addition, cardiac hydatid cysts originating from the interventricular septum carry the risk of rupturing into both ventricular cavities, which may lead to fatal complications. Thus, early surgical treatment is of extreme importance. We describe the case of a 7-year-old girl with a cardiac hydatid cyst that originated in the interventricular septum.     

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.     

Hydatid disease of the urinary tract: evaluation of diagnostic methods.

Eight patients with histologically proven hydatid disease of the urinary tract underwent eosinophil count, ultrasonography (US) and computed tomography (CT). The findings were compared with those in 8 age-matched controls with simple renal cysts. Eosinophilia was not significantly different in the 2 groups. Mixed echogenicity on US and multivesicular cyst with mixed density on CT were the diagnostic features of hydatid cysts. Using these factors, both US and CT could diagnose or exclude hydatid disease in a significant number of patients with renal cysts. However, CT was more sensitive (88 vs 50%) and accurate (94 vs 75%) than US in the diagnosis of urinary tract hydatid disease. Retrograde pyelography confirmed communicating renal hydatid cysts in 2 patients. A practical algorithm for the investigation of urinary tract hydatid disease is suggested.     

Clinical and radiographic features of simple and hydatid cysts of the liver

The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.     

A home-made device for safe intraoperative aspiration of pulmonary hydatid cysts

Surgical intervention is still the main modality for the treatment of hydatid disease. Different surgical procedure have been described; however, in the literature there is no collective agreement on the best surgical strategy. For intact pulmonary hydatid cysts, an enucleation or needle aspiration are possible strategies. Though, both methods need careful manipulation due to the serious complications after fluid rupture. Here, we present a novel technique that allows the aspiration of the cyst while reducing the risk of anaphylaxis and dissemination of disease. This is a home-made double suction device designed to aspirate hydatid cysts by creating a low pressure, wide mouth cylinder which holds the cyst wall against the base of the cylinder. A large thoracentesis needle is inserted across the low pressure chamber into the cyst to aspirate the fluid within. The complete evacuation of the cyst makes surgical treatment easier and facilitates its successive removal.