Huge retrovesical hydatid cyst with pelvic localization as the primary site: a case report

We present a patient with symptoms of abdominal pain and frequent urination due to a huge mass in the retrovesical region. All imaging modalities revealed a cystic mass containing small daughter cysts located between the urinary bladder and rectum. Its characteristics led us to suspect the presence of a hydatid cyst, and an indirect hemagglutination test for Echinococcus granulosus was found positive. No other involvement of hydatid cystic disease was detected. The primary site for the hydatid disease was therefore regarded as the pelvis, on which only a few cases have been reported previously. The patient started albendazole therapy, but refused operation. Hydatid cyst should always be considered in the differential diagnosis of abdominopelvic masses in endemic regions of the world.     

Percutaneous treatment of liver hydatid cysts: comparison of direct injection of albendazole and hypertonic saline solution

OBJECTIVE: The purpose of this study was to compare the effect of intracystic injection of albendazole and hypertonic saline in patients with liver hydatid disease. MATERIALS AND METHODS: Fifty-nine patients with a total of 109 hydatid cysts were treated percutaneously. In all cases, local anesthesia was applied. Twenty percent hypertonic saline was used in 31 patients (40 cysts, group 1) as the scolicidal agent, and albendazole solution was used in 28 patients (69 cysts, group 2). The PAIR (percutaneous puncture, aspiration, injection, reaspiration) method was applied in group 1. In group 2, we used a different procedure that could be called the PAI (percutaneous aspiration and injection) method. After this procedure, routine sonography and CT examinations were conducted. The results of both groups were compared. RESULTS: Follow-up examinations showed that liver hydatids expanded approximately to their original size after a significant reduction during the first month. In the follow-up period, fluid contents totally disappeared; thickening and irregularities were also observed in the cyst walls and a solid, hyperechogenic, heterogeneous pseudotumor appearance representing a degenerated membrane was seen in all patients. Hypertonic saline solution inactivated the scolices from the beginning of the treatment. However, scolices were inactive in the cysts aspirated 1 month after the procedure in group 2. A significant correlation was noted between elapsed time after the treatment and the cyst size using Wilcoxon's signed rank test (p = 0.000). No difference was seen between two groups in the amount of cyst size reduction using the Mann-Whitney test (p =0.521). CONCLUSION: In addition to its oral use, albendazole may be injected intracystically as we did in our study. It sterilizes the cyst cavity and affects scolices as well.     

Is the Adjuvant Albendazole Treatment Really Needed with PAIR in the Management of Liver Hydatid Cysts? A Prospective,Randomized Trial with Short-Term Follow-Up Results

Objective

The purpose of this study was to determine the safety and efficacy of adjuvant albendazole medication in percutaneous liver hydatid cyst treatment with puncture, aspiration, injection, and reaspiration (PAIR) method.

Methods

Between November 2007 and May 2011, total of 39 patients with newly diagnosed liver hydatid cyst (total of 77 cysts) were prospectively randomized and enrolled in 3 groups. In the first group, cysts (n = 14) were treated with PAIR without albendazole. In the second (n = 16) and third groups (n = 47), cysts were treated with PAIR with albendazole 1 week before and 1 month after the procedure, with albendazole 1 week before and 3 months after the procedure respectively.

Results

Technical and clinical success rates were 100 and 96.1 % respectively. In 3 of 77 cysts (3.9 %), findings of recurrence were detected on US imaging. All recurrent cysts were in group 1 and recurrence rates in this group were statistically different from cysts of second and third groups (p = 0.005). Side effects of albendazole were detected in 7 of 29 patients (24.1 %), and no statistically significant difference was observed between the second (15.3 %) and third (38.4 %) groups (p = 0.378).

Conclusions

Use of albendazole medication as an adjuvant to percutaneous treatment of liver hydatid cyst decreases the recurrence rate. Although there is no statistically significant difference between groups 2 and 3 in terms of efficacy and recurrence rate, patients in group 3 had a higher rate of side effect. Therefore, we conclude that albendazole treatment 1 week before and 1 month after PAIR treatment is sufficient to reduce/prevent recurrences.     

Percutaneous treatment of pulmonary hydatid cysts

Purpose To evaluate the safety and efficacy of percutaneous drainage of pulmonary hydatid cysts.Methods Eleven pulmonary hydatid cysts in eight patients were drained percutaneously after 1–2 years of treatment with mebendazole (50 mg/kg/day). Percutaneous needle aspiration was carried out under ultra-sound (US) in six patients and computed tomography (CT) in two patients. Nine cysts were close to, and two cysts were distant from the thoracic wall. After aspiration, hypertonic (15%) saline solution was instilled for up to 35% of the estimated volume of the cyst and aspirated 5–10 min later. Follow-up ranged from 8 to 31 months (mean 16.3 months).Results Neither anaphylactic shock nor death occurred in any of the eight patients. One patient developed fever, ipsilateral hydropneumothorax, and contralateral pleural effusion. One patient suffered from fever, pneumothorax, and abscess and was treated surgically; one developed fever and dyspnea. The volume reduction during follow-up was 47%–93%. The cystic contents turned into a pseudotumor appearance with a thick irregular contour on CT and higher Hounsfield units. On US, the cysts showed a heterogeneous content with internal echoes representing detached and degenerated membranes, and the fluid content almost completely disappeared.Conclusion We believe that percutaneous therapy of pulmonary hydatid disease is an effective alternative to surgical treatment in patients who have failed medical therapy.     

CT在囊型肝包虫活性判断中的应用价值

目的:探讨CT对囊型肝包虫活性特征影像学表现判断的价值。方法:40例经手术切除病理证实的共42个肝细粒棘球蚴包虫囊的影像学及术后记录囊内容物性状(液性,胶胨性,实变钙化)及内囊内原头节活性及内囊HE染色切片的镜下结构。结果:不同类型的包虫囊内其CT值差异有显著性意义(P<0.05);实变钙化组未见活性原头蚴的存在;CT显示囊内容物液态时囊内原头节活力明显高于胶冻性组(P<0.05),包虫母囊内原头蚴的活性随CT值的增大而减小;包虫内囊组织结构损害随内囊的剥离,塌陷而加重。结论:CT在包虫囊的活性程度的判断上具有重要的价值。     

Pyruvate: an in vivo marker of cestodal infestation of the human brain on proton MR spectroscopy

PURPOSE: To study intracranial cestodal cysts using in vivo proton magnetic resonance spectroscopy ((1)H MRS) in an effort to identify metabolite(s) that may help in recognizing the parasitic etiology and, perhaps, viability of such tapeworm cysts. Cestodal infestations of the human central nervous system (CNS)-cysticercosis and hydatidosis-are not rare. Identification of a scolex is considered diagnostic of cysticercosis on imaging. In its absence, however, the features are non-specific. MATERIALS AND METHODS: Three patients with intracranial hydatid cysts and 13 patients with intracranial cysticercal cysts (four intraventricular, seven parenchymal, and two subarachnoid racemose cysts) were studied on a 1.5-T MR system. In vivo (1)H MRS was performed by multivoxel two-dimensional hybrid chemical shift imaging technique (TE = 135 msec). In vitro (1)H NMR and mass spectroscopy (matrix assisted laser desorption/ionization [MALDI]) were performed on excised cysticercal and hydatid cyst fluid. MALDI spectra for pyruvate and succinate were also obtained. RESULTS: Alanine, pyruvate, and acetate were seen in all the three hydatid cysts. Lactate was seen in racemose cysticercal cysts. A large resonance at 2.4 ppm, confirmed as pyruvate at mass spectroscopy, was seen in 13 cestodal cysts. Pyruvate was not seen in one each of racemose, intraventricular, and parenchymal cysticercal cysts. CONCLUSION: Pyruvate is the predominant metabolite in cestodal cysts infesting the human CNS. It may be a marker of parasitic etiology and perhaps that of viability of such intracranial cysts.     

肾包虫囊肿的CT诊断

目的 :探讨肾包虫囊肿及其破裂感染的CT表现及诊断意义。材料和方法 :本组 7例患者均行CT平扫与增强扫描 ,经手术病理或临床资料证实。结果 :3例单纯型囊肿 ,2例表现为肾实质内水样密度的囊性肿物 ,其边缘光滑 :4例多子囊型囊肿 ,内部含有多个更低密度子囊。 2例破裂 /感染型 ,其内外囊分离 ,1例囊腔内有塌陷折叠并且钙化的内囊膜 ;另 1例囊周水肿并增强。结论 :CT对肾包虫囊肿的定位和定性诊断、分型以及破裂感染的判断颇为准确 ,是目前诊断肾包虫囊肿安全可靠的检查方法     

Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?

AIM: To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. MATERIALS AND METHODS: Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. RESULTS: Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. CONCLUSION: Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts.     

Albendazole treatment of cerebral hydatid disease: evaluation of results with CT and MRI

We report a case of cerebral hydatid disease demonstrated by CT and MRI, treated with albendazole. Follow-up showed complete dissapearance of the cysts with residual focal calcification on CT and presumed gliosis on MRI. Received: 25 April 1997 Accepted: 25 May 1997     

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.     

Percutaneous treatment of hydatid liver cysts in children as a primary treatment: long-term results

PURPOSE: To evaluate the effectiveness and long-term results of percutaneous treatment for hydatid liver cysts in pediatric patients. MATERIALS AND METHODS: Thirty-four pediatric patients (15 male, 19 female; ages 4-17 years; mean age, 9.4 years) with 51 hydatid liver cysts underwent ultrasound (US)-guided percutaneous treatment with albendazole prophylaxis. There were 15 type II lesions with membrane detachment and 36 type I lesions resembling simple hepatic cysts with pure anechogenic content or small echogenic reflections and a regular well-delineated wall. The method of US-guided puncture, aspiration, injection of hypertonic saline solution, and reaspiration was preferred for 21 lesions. For the remaining 30 larger cysts, the intervention was performed with the same percutaneous technique but followed by catheterization, drainage, control cystography, and sclerotherapy with ethanol. During follow-up, US examinations were performed at 1, 3, 6, and 12 months for the first year and yearly thereafter. RESULTS: Percutaneous treatment of hepatic hydatid disease was successful in 33 patients (97.1%). During follow-up, US findings in the lesions changed significantly; at year 1, the inner content of the lesions became heterogeneous with a semisolid appearance, and the mean reduction in volume was 81.4%. At 2-year follow-up, most hydatid cysts had become solid in nature and the reduction in volume reached 65%-99% (mean, 85.1%). There were no recurrences or additional lesions after the follow-up of 1-6 years (mean, 3.1 years). Average hospital stay for the whole group in this study was 3.5 days. CONCLUSIONS: The long-term results of percutaneous liver hydatid cyst treatment in children are in accordance with the results in adults. Percutaneous treatment of uncomplicated type I and type II liver hydatid cysts in pediatric patients is an efficient and safe treatment with short hospitalization.     

Computed tomography and magnetic resonance imaging findings in cerebral hydatid disease

Purpose: The purpose of this study was to describe the discriminative computed tomography (CT) and magnetic resonance imaging (MRI) features of cerebral hydatid disease.Methods: The CT and MRI findings of four cases of surgically proven cerebral hydatid cysts were retrospectively reviewed. Results: CT demonstrated well-defined cystic lesions with no perilesional oedema and no contrast enhancement in all cases except one recurrent disease that showed both peripheral oedema and rim enhancement. MR images revealed well-defined cystic lesions with a quite clear rim that showed relative hypointensity limited to some aspects of the cyst walls on T2-weighted images. The cysts were spherical and obvious mass effect was observed on both CT and MR examinations. Conclusions: Although the cystic nature of intracranial hydatid disease could be equally well demonstrated on CT and MR examinations, CT is superior in detecting calcification of the cyst wall or septa, when present, and MR is better in demonstrating cyst capsule, detecting multiplicity and defining the anatomic relationship of the lesion with the adjacent structures and helps in surgical planning.     

Radiological characteristics of pulmonary hydatid disease in children: less common radiological appearances

OBJECTIVE: To evaluate the chest roentgenogram and CT characteristics of pulmonary hydatid disease (PHD). MATERIAL AND METHODS: Forty-seven (27 male and 20 female, aged between 3 and 11 years) consecutive pediatric patients with surgically proven pulmonary hydatid cysts were enrolled for the study. Posteroanterior and lateral chest roentgenograms, CT of the chest, and laboratory findings (latex agglutination, Casoni skin test, and eosinophil count) were obtained from all of the patients. The radiological features (localization, internal architecture, number, diameter) were determined. RESULTS: On CT examination, a total of 79 cysts were determined. On chest roentgenogram, 57 of 79 cysts were detected in all patients. Single cysts were seen in 33 patients, while multiple cysts were seen in 14. Median CT density of the cysts was 21 Hounsfield units (HU) (0-80). There were six giant cysts (>10 cm of cyst diameter). The crescent sign, water lily sign, and air-fluid level were seen in two, five and eight of the cysts, respectively. Apart from the classically described features of pulmonary hydatid cysts of the lung, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was detected in three cysts. All of the liquid content of the cyst was expelled to the bronchial system (dry cyst sign) was observed in seven cysts. There were two infected cysts. Heavily calcified curvilinear cyst wall was present in one cyst. Pericystic reaction in the lung tissue was observed in five patients. Other features included pleural effusion (n=2), mediastinal shift (n=6) and atelectasis (n=7). CONCLUSIONS: Chest roentgenogram is helpful for diagnosis of intact cysts but, it is impossible to define entire morphology of the complicated cysts. CT imaging recognize certain details of the lesions and discover others that are not visible by conventional radiography. In conclusion, CT examination should be done to elucidate cystic nature of the lung mass and for accurate localization in the preoperative period. In addition, inverse crescent sign should be recognized as feature of pulmonary hydatid cysts on CT.     

Adverse effects of longterm, continual administration of high doses of albendazole in the treatment of echinococcal disease

BACKGROUND/AIM: Modern treatment of cystic echinococcosis, except for surgical treatment and percutaneous drainage of cyst considers also administration of albendazole as a type of individual therapy. However, clinicians fear of the serious adverse effects of high doses of albendazole, first of all the elevation of serum transaminases activity, very frequently results in subdosing of albendazole and wrong conclusions its efficacy and safety. The aim of this study was to investigate adverse effects of a longterm, continual administration of high doses of albendazole in the treatment of patients with echinococcal disease. METHODS: A total of 42 patients (mean age 40.4 +/- 18.3 years) with echinococcal disease were included in the study. They were treated with continual administration of high doses of albendazole within the period of 4 to 6 months. The subgroups of 27 and 15 patients were treated with 15-20 mg/kg/day and with 21-25 mg/kg/day albendazole, respectively. The patients in the control group (18 with surgical treatment, 6 with percutaneous drainage of cyst) were treated with 800 mg albendazole per day (< 15 mg/kg body weight) in the cycles of 28 days (1-3 cycles) and a two-week pause between them. RESULTS: In the study group adverse effects of albendazole were registered in 20 (47.6%), whereas in the control group in 6 (30.0%) of the patients. In both subgroups elevated activity of serum transaminases were found more frequently in the study group compared to the control one (35.7% vs 25%, p < 0.05), especially in the patients who were treated with higher doses of albendazole. The patients in the study group, compared to the patients in the control group had significantly higher mean activity of serum alanin aminotransferase in the course of the second and third month of the therapy (p < 0.05). Administration of albendazole due to adverse effects was stopped in 3 (7.1%) of the patients in the study group. Two (4.8%) of them had a very high activity of serum transaminases and one had a muscle pains and high activity of serum creatine kinase. After the interruption of the therapy we documented a nonnalization of serum enzyme levels in all the patients. CONCLUSION: Longterm, continual administration of high doses of albendazole in the patients with echinococcal disease results in significant elevation of serum transaminases activity, compared to the patients treated with albendazole in the cycles, but in the majority of the patients serum transaminases activity was normalizated by the end of a 6-month period.     

Evaluation of response to chemotherapy of human cystic echinococcosis

Fifty-five patients with echinococcosis were treated with mebendazole (30) and albendazole (25). To determine changes in cyst morphology and to evaluate the varying degree of response, progress during follow-up was shown by radiography, computerized tomography and ultrasonography. Persistence of cysts without any change in the morphology and cyst enlargement were taken as criteria for unsuccessful treatment. Development of echogenic foci and increase in density of cyst fluid were considered as a therapeutic effect. Changes in cyst wall such as thickening and deposition of calcium and detachment of the cyst membrane may also indicate response. An essential criterion, for a positive drug effect, was cyst size reduction as well as shape deformation. However, the most convincing and reliable criterion was the complete disappearance of hydatid cysts. Comparative assessment of the therapeutic effect of the two drugs favoured albendazole.     

Computed tomography of pulmonary hydatid disease

The CT findings in 20 patients with pulmonary hydatid disease were reviewed. Sixty-four intrapulmonary cysts were imaged, 22% of which were ruptured or complicated. Simple hydatid cysts and water-density lung cysts of other etiology may have a similar CT appearance; however, the demonstration of the cystic nature of a lung lesion in endemic areas makes hydatid disease the primary consideration. Pathognomonic features in ruptured or complicated hydatid cysts that can be visualized better by CT than by conventional radiography include detached or collapsed endocyst membrane(s), collapsed daughter cyst membranes, and intact daughter cysts.     

肝包虫病的磁共振诊断

本文对手术证实的８例肝包虫囊肿及５例肝泡状棘球蚴病的磁共振成像（ＭＲＩ）进行分析。包虫囊肿表现为圆形、卵圆形边缘光滑的影像，Ｔ１加权像呈低信号，Ｔ２加权像呈高信号。其特征性表现为病变有光滑均匀的低信号强度的囊壁及呈多房性的子囊，为ＭＲＩ诊断本病的重要依据。泡状棘球蚴呈巨块型，在Ｔ１和Ｔ２加权像上均呈低信号，境界不清，边缘不规整，中心液化坏死，呈溶岩状，偶见颗粒状钙化。还探讨了本病与非寄生虫性占位病     

纵隔棘球蚴病的CT表现

目的:探讨纵隔棘球蚴病的CT表现。方法:回顾性分析10年以来的5例纵隔棘球蚴囊肿的CT影像特点。结果:5例病灶为圆形或椭圆形囊性肿块,壁略厚。2例病灶为单囊型,其中1例病灶囊肿壁钙化;3例病灶为多囊型,其中2例病灶囊肿壁有钙化。增强扫描棘球蚴囊肿壁均强化明显。结论:CT对纵隔棘球蚴病定位、定性有较高的诊断价值。     

Ultrasound diagnosis of liver hydatid disease

A clinical study of 42 patients with hydatid disease was carried out using a real-time gray scale B-scanner. All cases were confirmed surgically. The ultrasound characteristics of the hydatid cysts were classified into three groups: Type I, simple hydatid cyst (19 of the 42 cases), type II, hydatid cyst with a disrupted wall and septa (14 cases), and type III, hydatid cyst with a heterogeneous echo pattern (9 cases). It was concluded that ultrasound classification of the cysts increases diagnostic accuracy. However, if a hydatid cyst becomes secondarily infected these typical changes are lost and the ultrasound diagnosis may then become more difficult. Periodic examinations should be performed with ultrasound after surgery.     

Sylvatic pulmonary hydatid disease a radiologic survey.

The study assesses the radiologic pattern of endemic sylvatic hydatid disease in Canada. Seventy-five pulmonary hydatid cysts, proved surgically and histologically, were studied from a group comprising fifty-five Indians, five Eskimos and four white patients for the years 1949-1972. Cysts were classified as unruptured or ruptured. Epidemiology, life cycle and pathophysiology are considered in addition to radiology. The majority of cysts appeared to be smaller than the pastoral form found abroad, most were solitary, and all showed characteristic features during growth. The features of cyst rupture are classified and assessed.