Primary spinal intradural extramedullary hydatid cyst in a child

BACKGROUND/OBJECTIVE: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. CASE REPORT: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. CONCLUSION: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.     

Management of complicated hydatid cyst of the thorax

BACKGROUND: Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hydatid disease. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical therapy and the delay of surgical treatment in pulmonary hydatid disease. METHODS: Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approach in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%). RESULTS: In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3-17 days). The mean follow up was 18.4 months with no recurrence. CONCLUSION: Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.     

Hydatid Cyst in the Pulmonary Artery: An Uncommon Localization

Abstract Pulmonary artery involvement of hydatid disease caused by the Echinococcus granulosus parasite is an uncommon condition resulting from the opening of a visceral hydatid cyst into the venous circulation or the rupture of a cardiac hydatid cyst. We report a case of a 31-year-old woman with a hydatid cyst located in the right pulmonary artery. Clinical presentation was fatigue, cough, and dyspnea. Diagnosis was made by chest x-ray, computed tomography, and magnetic resonance imaging. The cyst was extracted under total circulatory arrest. Diagnosis and surgical therapy of the intraluminal pulmonary arterial hydatid cyst prevented possible occurrence of severe complications, such as cyst rupture, anaphylactic shock, and sudden death.     

Acute pulmonary embolism due to the rupture of a right ventricle hydatic cyst.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report a case of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. Pulmonary angiography showed right pulmonary occlusion. Echocardiography, computed tomography scan and magnetic resonance imaging showed images suggesting a hydatid cyst. The patient underwent sternotomy and cardiopulmonary bypass in order to treat the heart cyst and remove the hydatic pulmonary obstruction. A concomitant lung hydatid cyst was extirpated.     

Risk for laparoscopic fenestration of liver cysts

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts. Conversely, the laparoscopic approach for the management of hydatid simple liver cysts is not widely accepted because of the risk for severe complications. Despite improvement in imaging techniques, the probability of preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore, laparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst. Methods: From January 2000 to January 2001, 15 patients with a diagnosis of liver cyst underwent laparoscopy for fenestration. In all cases preoperative serologic and imaging assessment had excluded hydatid liver cyst. To further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed. Results: In two patients with presumedly simple liver cyst, hydatid liver cyst was diagnosed instead at laparoscopy by aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy. Conclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a solitary cyst, should be considered before laparoscopic fenestration is performed. Intraoperative aspiration of cyst fluid before fenestration can minimize this risk, thus avoiding severe intraoperative and late complications.     

Periventricular hydatid cyst

Periventricular localization of hydatid cyst is very rarely seen. A 5-year-old boy with periventricular hydatid cyst is presented. He had right hemiparesis and focal seizures. Computerized tomographic scan showed a hydatid cyst in the left periventricular area. Hydatid cyst was successfully removed. The postoperative course was uneventful.     

Primary Spinal Intradural Extramedullary Hydatid Cyst in a Child

Abstract

Background/Objective: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease.

Case Report: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal.

Conclusion: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.     

Primary hydatid cyst of the brain during pregnancy

A 26-year-old woman in the 28th week of pregnancy presented with a primary cerebral hydatid cyst manifesting as deteriorating consciousness and weakness in the left arm and leg. Cranial computed tomography revealed an intracranial hydatid cyst. The cyst was surgically removed and albendazole was administered. The patient had a spontaneous vaginal term delivery and no problem was observed in the mother or child. No primary focus was found in the lungs, liver, and other organs. Hydatid cyst is still an important disease. Intracranial hydatid cyst without primary foci in organs such as the liver and lungs is very rare. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention.     

Concurrent intrapericardial–pulmonary hydatidosis: an unusual multisystem echinococcosis

A 46-year-old male presented with breathlessness for a few months. He had been operated twice for liver hydatid cysts and once for right pulmonary hydatid cysts at other hospitals. Now he was found to have one hydatid cyst in the upper lobe of the left lung and multiple hydatid cysts adjoining left heart border. On computed tomography (CT) scan chest and echocardiography, it was difficult to ascertain whether these cysts were pulmonary or intrapericardial. Left ventricular ejection fraction (LVEF) was 25%. Enzyme-linked immunosorbent assay (ELISA) was positive for hydatid. Left posterolateral thoracotomy revealed dead hydatid cyst in upper lobe of the lung that was removed. Infected mother hydatid cyst was encountered inside pericardial sac. Scores of daughter hydatid cysts, varying in size from 1 to 30 mm, were scooped out intact from the pericardial cavity. There was significant improvement in cardiac activity, once the tamponade effect of hydatid cyst was removed. Pericardium was about 1 cm thick with lot of purulent and necrotic slough. To prevent future constrictive pericarditis, subtotal pericardiectomy was done. Intrapericardial hydatid cyst should be kept in mind whenever it obscures the heart border and patient has features of cardiac tamponade. Early surgical intervention may be required in these cases.     

Giant Renal Hydatid Cyst Resembling a Simple Cyst: An Intraoperative Diagnosis

An interesting case of a giant renal hydatid cyst is presented. The big cystic mass detected at ultrasonography (US) and computerized tomography (CT) in a ten-year-old girl looked like a simple cyst. No germinative membrane or any other radiological sign of a hydatid cyst was present. The operation was planned for a simple cyst; but was altered, after an intraoperative diagnostic needle sampling brought out the characteristic fluid of hydatid cyst. We came to the conclusion that hydatid cystic masses may not always present with their characteristic radiological findings; and that extreme caution should be practiced by the radiologist and the surgeon in order to prevent iatrogenic echinococcal dissemination.     

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.     

Primary giant hydatid cyst of the diaphragm.

We report a case of an hydatid cyst of diaphragma in a 34-year-old female who was admitted to our clinic for right basithoracic pain. Magnetic resonance imaging (MRI) reported a giant hydatid cyst including multiple vesicles at the right lower thoracic cavity. Surgical exploration revealed an independent giant diaphragmatic hydatid cyst. We performed cystotomy and more than 200 daughter vesicles were removed from the cyst. The rest of the giant cyst cavity was excised.     

Secondary gallbladder hydatidosis and nonfragmanted germinative membrane sourced obstructive jaundice caused by intrabiliary ruptured hepatic hydatid cyst (a case report): two rare complication of the intrabiliary ruptured hepatic hydatid cyst

Intrabiliary rupture is the most frequently seen complication of the hepatic hydatid cysts. Obstructive jaundice can be seen as a complication of the intrabiliary ruptured hepatic hydatid cysts due to the migrated cystic content into bile ducts. In this study, we present two rare complications seen in a patient who has intrabiliary ruptured hepatic hydatid cyst. Obstructive jaundice and secondary gallbladder hydatidosis depending on to the intrabiliary ruptured hepatic hydatid cyst in a 58-year-old man patient were diagnosed and treated. A large choledochal nonfragmanted germinative membran was found in the choledochus as the reason of biliary obstruction. Hepatic hydatid cyst is a world-wide disease. Intrabiliary rupture must be kept in mind in the patients who has hepatic hydatid cyst and biliary tract problems.     

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.     

Hepatic hydatid cyst ruptured in the peritoneum

Romania is an endemic region for hydatid cyst and has a high incidence of hepatic hydatid cysts. If the intrabiliary rupture is the most frequent complication encountered, rupture in the peritoneum is rare, with exact data not available. Between 1993-2002 160 patients with hepatic hydatid cysts were operated. Six of them had an intraperitoneal ruptured cyst. Ultrasound raised the suspicion of hepatic hydatid cyst ruptured in the peritoneum in 4 cases, in one case the intact cyst migrated in the lower abdomen were it was mistaken for an ovarian cyst. After a thorough lavage with hypertonic serum, the parasite was evacuated, the pericyst partially removed and the cavity collapsed with non-absorbable sutures. The postoperative course was uneventful. Prophylaxis with benzimidazolic drugs started days 2-3 PO. At a follow-up between 1-4 years no peritoneal hydatidosis was detected. In the intraperitoneal ruptured hydatid cyst the hypertonic serum and benzimidazolic drugs can be useful in preventing peritoneal seedings.     

Recurrent anaphylactic shock as a manifestation of echinococcosis. Report of a case

Hydatid disease, caused by the cestode Echinococcus granulosus, is common in Mediterranean regions, being highly endemic in Greece. Depending on its size, an intact hydatid cyst may be "silent" or may cause symptoms from compression of adjacent organs. Rupture of a hydatid cyst commonly gives to allergic phenomena, which can include anaphylactic shock. A case is presented in which there was a two-year history of recurrent anaphylactic shock due to small, incomplete ruptures of hydatid cyst. The case emphasizes the potentially life-saving importance of early diagnosis of hydatid cyst.     

Study of the Radical vs. Conservative Surgical Treatment of the Hepatic Hydatid Cyst: A 10-Year Experience

The hepatic hydatid cyst is a major health problem in endemic areas. Surgery is still the best choice for the treatment of hydatid cyst of the liver. There is controversy regarding efficacy of radical versus conservative surgical approaches. In this study, we aimed to evaluate the two surgical methods in patients treated for the hepatic hydatid cyst. This is a retrospective review of the medical records of 135 patients who underwent surgery for the hepatic hydatid cyst from 1993 to 2003. Surgery comprised conservative methods (evacuation of the cyst content and excision of the inner cyst layers) and radical methods (total excision of the cyst and removal of its outer layer). One hundred thirty five patients underwent liver surgery. Conservative surgery was performed for 71 (53%), whereas, the remaining 64 patients (47%) underwent radical surgery. Local recurrence rate of the cysts was lower in the radical versus conservative surgery group and the mean length of hospital stay was shorter in the radical surgery group. Radical surgery of the hepatic hydatid cyst may be the preferred treatment because of its low rate of local recurrence, as well as short hospital stay.     

Laparoscopic cystectomy for splenic hydatid cyst: a case report

Even in countries where it is considered endemic, splenic hydatid cyst is a very rare disease in childhood. Partial or total splenectomy has generally been the treatment of choice for this condition. This is the first report of laparoscopic cystectomy as treatment of isolated splenic hydatid cyst in childhood. A 10-year-old girl with isolated splenic hydatid cyst was successfully treated by laparoscopic cystectomy and splenic preservation. The authors have demonstrated that laparoscopic cystectomy for an isolated splenic hydatid cyst is technically feasible, safe, and is associated with a shorter hospital stay and good cosmetic appearance.     

Coronary artery bypass in myocardial ischemia of the young due to hydatid cyst

Abstract   Cardiac hydatid cyst is an uncommon disease, especially in France. It is rarely responsible for myocardial ischemia, and even more rarely in the young. We report the clinical features and imaging of a 24-year-old Tunisian woman with hydatid cyst of the free wall of the left ventricle responsible for myocardial ischemia, associated with a hepatic hydatid cyst. Management consisted of a combination of surgery with cystopericystectomy and coronary artery bypass graft and prolonged medical treatment as for treatment of hepatic hydatid cyst. Three-year follow-up revealed no recurrence. This case illustrates two interesting points: the rare clinical presentation of cardiac hydatid cyst with a coronary syndrome in a young 24-year-old woman related to compression of the left anterior descending artery by the cyst with a need for coronary artery bypass graft after resection of the cyst, and the value of medical treatment of hydatid disease, even for cardiac localization.     

Evaluation of Different Chemical Agents on the Germinative Layer of Sheep Hydatid Cyst After Implantation to Peritoneal Cavity of Balb/C

In spite of the use of protoscolocidal agents during hydatid cyst surgery, a notable rate of disease recurrence in postoperation patients is still observed. The question remains whether living protoscolices lead to recurrence or the recurrence is due to the remainder of the germinative layer in the peritoneal cavity. The aim of this study was in vivo evaluation of different chemical (protoscolicidal) solutions on the germinative layer of the hydatid cyst. The germinative layer of sheep hydatid cyst was separated under sterile condition, divided into 0.25-cm² parts, and exposed to 0.5% cetrimide, 0.5% silver nitrate, 20% hypertonic saline, 15% dextrose and 25% dextrose, and normal saline as negative control for 2 min. The exposed germinative layers were implanted into the peritoneal cavity of 90 Balb/C mice (15 mice in each group). After nine months, the peritoneum was evaluated macroscopically as well as microscopically for the presence of any hydatid cyst. No hydatid cyst was observed in the peritoneal cavity of the exposed mice. The role of the germinative layer for inducing hydatid cysts in mice is questionable. However, the present study showed that the germinative layer had no role in the induction of hydatid cyst in these laboratory animals.