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Findings in this case: 1) Multiloculated cystic mass in the RIGHT lobe of the liver. 2) Dilated common duct. Minimal dilatation of the intrahepatic ductal system.
Diagnosis: Hydatid disease.
File: 4A
Organ System: 4. Hepatobiliary System.
Organ: A. Liver.
Information:
Etiology an incidence: 1) The etiology is the echinococcus granulosus and echinococcus multilocularis. 2) E. granulosus typically develops into large unilocular or multilocular cystic masses. Seen more commonly in the Mediterranean area, Australia/New Zealand, Africa and South America where contact with sheep may be more prevalent. Humans are the intermediate hosts while the dog is the definitive host. 3) E. multilocularis more typically appears as a multilocular and/or a complex cystic mass. More common in Europe and Northern climates. Humans are the intermediate hosts while the wolf is the definitive host. 4) The liver is the most common organ wall, however the lungs and kidneys are also frequently involved.
Diagnosis: 1) Clinical: Patients present with symptoms typically when the cysts become large enough. Time to diagnosis is years due to slow enlargement. RIGHT upper quadrant pain, fever and jaundice. RIGHT upper quadrant mass/hepatomegaly. Positive serology greater than 80% of cases. Eosinophilia is frequently seen. Can have allergic reactions including anaphylaxis following rupture. 2) Radiologic: A) CT: Multilocular cystic and/or complex solid appearing mass. Curvilinear calcifications in the cyst walls. The septa enhance. If solid masslike tissue is present this may or may not enhance. B) MRI: On T1, the main/mother cyst is of intermediate intensity with the daughter cysts of slightly decreased intensity in comparison. On T2, there is increased signal intensity. On T1 with contrast, similar findings are present to the CT with contrast. Septa can enhance however more solid tissue enhances variably. C) Ultrasound: Multilocular cystic mass with occasional internal echoes versus complicated appearing solid and cystic mass. D) Differential Diagnosis: Abscess, biliary cystic adenocarcinoma, hemorrhagic and/or infected cyst, necrotic hepatic carcinoma and complex metastatic cystic masses e.g. ovarian carcinoma or sarcoma.
Prognosis: 1) Prognosis is good following treatment. With E. multilocularis, if untreated the patients can die. 2) The cysts can rupture into the peritoneum or the biliary tract. 3) Multiorgan involvement can be seen. 4) Treatment: Percutaneous drainage and medical therapy with some cases requiring surgical resection.
References:
Hydatid Disease: Radiologic and Pathologic Features and Complications: (CME Available in print version and on RSNA Link) Radiographics May 2000 20:795-817
Iván Pedrosa, Antonio Saíz, Juan Arrazola, Joaquín Ferreirós, and César S. Pedrosa …3 Beggs I.
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Hydatid Disease from Head to Toe Radiographics March 2003 23:475-494; doi:10.1148/rg.232025704
Pinar Polat, Mecit Kantarci, Fatih Alper, Selami Suma, Melike Bedel Koruyucu, and Adnan Okur
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Purely cystic hydatid disease of the liver: treatment with percutaneous aspiration and injection of hypertonic saline. Radiology February 1992 182:541-543
B Acunas, I Rozanes, L Celik, O Minareci, G Acunas, A Alper, O Ariogul, and E Gökmen
Liver hydatid disease: long-term results of percutaneous treatment. Radiology January 1996 198:259-264. O Akhan, M N Ozmen, A Dinçer, I Sayek, and A Göçmen
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