Hemoptysis in a 28-year-old active duty soldier

A 28-year-old African American male, originally from West Africa, presented with complaints of cough and hemoptysis. This case follows the patient through transfer to Walter Reed Army Medical Center and outpatient follow-up. Exploring this case illustrates how an Army physician may approach a soldier with hemoptysis. Additionally, this case demonstrates the management and treatment of his condition.     

Imaging in pulmonary hydatid cysts

Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored.     

Multiple cerebral hydatid cysts

A 39-year-old woman was admitted to hospital with headaches, vomiting, psychic impairment and diplopia. Three hydatid cysts of the lung had been previously removed. An avascular mass in the left hemisphere with left-to-right displacement of the anterior cerebral arteries was noted during a brain angioscintigraphy. A computed tomography (CT) brain scan showed two cystic lesions situated in the left-frontal and occipital regions. A CT abdominal scan showed multiple cysts in the liver, spleen and both kidneys. At operation, two brain cysts were totally extirpated without rupture. The definite pathological diagnosis was secondary hydatid cysts. The headaches, vomiting and diplopia were persistent in the post-operative period. Seven days after the operation, a CT brain scan showed an infratentorial cyst. The patient rejected any surgical intervention.     

Multiple cerebral hydatid cysts

A 39-year-old woman was admitted to hospital with headaches, vomiting, psychic impairment and diplopia. Three hydatid cysts of the lung had been previously removed. An avascular mass in the left hemisphere with left-to-righ displacement of the anterior cerebral arteries was noted during a brain angioscintigraphy. A computed tomography (CT) brain scan showed two cystic lesions situated in the left-frontal and occipital regions. A CT abdominal scan showed multiple cysts in the liver, spleen and both kidneys. At operation, two brain cysts were totally extirpated without rupture. The definite pathological diagnosis was secondary hydatid cysts. The headaches, vomiting and diplopia were persistent in the post-operative period. Seven days after the operation, a CT brain scan showed an infratenrorial cyst. The patient rejected any surgical intervention.     

MR in cisternal hydatid cysts.

We describe a case of multiple hydatid cysts in the cerebral subarachnoid space. The diagnosis was based on clinical findings, latex test results, cerebrospinal fluid examination, and MR imaging findings.     

Intracranial and orbital hydatid cysts

Summary Parasitic diseases involving brain and orbit are relatively rare in Tunisia; the most frequently encountered is the hydatid cyst, 55 examples of which were seen since CT scanning was introduced into Tunisia 2 years ago. Various aspects of the intracerebral and orbital hydatid cysts are reported and a tentative classification is made based on characteristics revealed by CT.     

Migrating and herniating hydatid cysts

OBJECTIVE: To present the prevalence and imaging findings of patients with hydatid disease (HD) showing features of migration or herniation of the hydatid cysts (HCs) and underline the clinical significance of this condition. MATERIALS AND METHODS: Between May 2003 and June 2006, 212 patients with HD were diagnosed by abdomen and/or thorax CT, searched for migrating or herniating HC. Imaging findings of 7 patients (5 women, 2 men with an age range of 19-63 years; mean+/-S.D., 44+/-19 years) with HD showing transdiaphragmatic migration (6 subjects) or femoral herniation (1 subject) were evaluated. Diagnosis of all the patients were established by pathologic examination and migration or herniation was confirmed by surgery in all patients. RESULTS: Liver HD were identified in 169 (79.7%) of 212 patients with HD. Transdiaphragmatic migration of HCs were identified in 6 (3.5%) of the 169 patients with liver HD. In one patient, femoral herniation of the retroperitoneal HC into the proximal anterior thigh was identified. All of these seven patients exhibiting migration or herniation of HCs had active HCs including 'daughter cysts'. Two patients had previous surgery because of liver HD and any supradiaphragmatic lesion was not noted before operation. Findings of migration or herniation were confirmed by surgery. CONCLUSION: Active HCs may show migration or herniation due to pressure difference between the anatomic cavities, and in some of the patients, by contribution of gravity. Previous surgery may be a complementary factor for migration as seen in two of our patients. The possibility of migration or herniation in patients with HD should be considered before surgery.     

A 20-year-old active duty male soldier with tachycardia and palpitations during Operation Iraqi Freedom

A 20-year-old active duty male presented with palpitations, tachycardia, and a nontender, diffusely enlarged thyroid. The differential diagnosis and appropriate management of this patient's symptoms and physical examination findings are reviewed. Various diagnostic modalities are highlighted and effective treatment strategies as well as their risks and benefits are discussed.     

Uncommon locations of hydatid cysts

Hydatid disease is endemic in many parts of the world. It may develop in almost any part of the body. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% occur in the rest of the body. In this article, the various imaging findings of hydatid cysts in unusual localizations are reviewed, based on our experience. Findings in brain, cavernous sinus, submandibular gland, thyroid gland, heart, pleura, chest wall, retrocrural tissue, kidney, spleen, pancreas, peritoneal cavity and inguinal canal, breast, bone and soft tissue are discussed.     

单纯性脾包虫1例

患者女,40岁。左上腹部疼痛7年余,近2年加重。患者近几年有与羊狗接触史,无外伤史,亦无胰腺炎史。体检:脾大,约于肋缘下三指。一般情况良好,胸片示心肺膈未见异常。实验室检查:包虫皮肤试验阳性,其它未见异常。入院前彩色多普勒超声示:脾实质内囊性肿块(多房性),临床初步诊断为     

Percutaneous treatment of liver hydatid cysts

Hydatic disease caused by Echinococcus granulosus is an endemic disease and an important public health problem in some countries of the world. The results of surgical treatment are associated with a high rate of mortality, morbidity, postoperative recurrence and a long period of hospital stay and the medical treatment results are still controversial. Although the percutaneous aspiration and treatment of liver hydatid cysts were considered to be contraindicated due to risks of anaphylactic shock and dissemination of clear-crystal fluid into the abdomen, several reports of successful percutaneous treatment of liver hydatid cysts have been published in the literature. Today, percutaneous treatment of liver hydatid cysts is the most effective and reliable treatment procedure in the selected cases. In this review, indications, contraindications, method and techniques, healing criteria, complications, results and importance of the percutaneous treatment of liver hydatid cysts are discussed.     

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 characterization of multivesicular hydatid cysts

One hundred seventy-eight abdominal multivesicular hydatid cysts were classified into three types (A, B, C) based on CT densities and morphology of cysts. The CT density of viable daughter cysts was always appreciably lower than those of mother hydatid cysts. This density differential between mother and daughter hydatid cyst fluid is a useful diagnostic sign.     

Cerebral hydatid cysts: CT findings

Summary The CT features of cerebral hydatid cysts are divided into two groups. In the unilocular cases, the cyst is large, spherical in shape with sharply defined borders. One side of the cyst wall is very close to the calvarium. The cyst may calcify and may have septae inside. There is no enhancement with contrast media and also no edema surrounding the cyst. In the second group there are multiple and small multilocular cysts. These cysts are in ovoid or polygonal forms like a bunch of grapes, with perifocal edema. After contrast media administration, there is enhancement in the cyst wall. In one case there were numerous cysts in both hemispheres.     

CT demonstration of pelvic hydatid cysts

We describe the computed tomographic findings in two cases of bilateral hydronephrosis due to hydatid cyst located in the pouch of Douglas. In both cases this location was secondary to the spontaneous rupture of an hepatic cyst.     

Magnetic resonance imaging signal characteristics in hydatid cysts

The MRI features of hydatid cysts were retrospectively studied in 12 patients to look for specific signal characteristics. Twelve patients in the series included eight with abdominal, two with abdominal-pelvic, one with a sacral and one with a lung hydatid cyst. The T1-, T2- and proton density (PD)-weighted images of spin-echo sequence were used for imaging. The signal characteristics of the hydatid parent cyst capsule and fluid, daughter cyst fluid, detached germinal membrane and surrounding soft tissue reaction were noted. Observations revealed that the capsule is best seen on T2- and PD-weighted images. The daughter cysts are best demonstrated on T1-weighted images, whereas the difference in the signal intensities of parent cyst and daughter cyst fluid is better demonstrated on T2-weighted and T1-weighted images, and the detached germinal membrane is best seen on T2- and PD-weighted images. The signal characteristics of hydatid cyst morphology can help distinguish it from other entities.     

Multiple intracranial hydatid cysts: MR findings

Multiple intracranial hydatid cysts are uncommon and usually localized in the supratentorial compartment. We report a case studied by CT and MR of multiple intracranial hydatid cysts scattered in various anatomic sites: supratentorial, infratentorial and also intraventricular. Correspondence to: J. M. Pumar Cebreiro