Pulmonary Hydatid without Liver Involvement: A Case Series

Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.

Application of a single-chain fragment variable (scFv) antibody for the confirmatory diagnosis of hydatid disease in non-endemic areas

Background: Hydatid disease is a serious parasitic disease threatening public health. Because of its rarity in non-endemic coastal areas, determining the nature and origin of a chronic, enlarged liver cystic mass is challenging in these regions. Under these circumstances, physicians need a confirmatory diagnostic tool beyond immunological and radiological examinations. This study investigated a novel human single-chain fragment variable (scFv) antibody for the confirmative diagnosis of 18 atypical hydatid disease cases in non-endemic coastal areas. Results: A scFv antibody against cystic echinococcosis was produced by genetic engineering and then applied to the immunohistochemical diagnosis of 18 cases of cystic echinococcosis presented in non-endemic coastal areas. The diagnosis of these cases by ultrasound and serum-based examinations was inconclusive. The 750 bp scFv antibody gene was expressed in COS-7 cells, and the antibody localized in the cytoplasm. The scFv antibody can detect the germinal layer and protoscolices of actively growing cysts but not of the degenerating protoscolices and has a diagnostic efficiency higher than that of single serum or ultrasound testing (P b 0.05). The combined use of scFv antibodies with serology and ultrasound diagnostics results in a diagnostic efficiency comparable to that of surgery. The scFv antibody can be used as a confirmatory test for the diagnosis of hydatid disease in non-endemic areas, providing a beneficial supplementary diagnostic method that complements traditional immune testing and ultrasonic radiology and thus helping physicians to effectively differentiate hydatid disease.

Evaluation of cystic lesions of liver by ultrasonography

Background: Ultrasonography is very sensitive in detecting cystic lesions of liver, which helps in detecting various lesions, along with the internal structures of the body. One gets an opportunity to evaluate additional information of other abdominal organs that can modify the course of treatment and prognosis of patient. Aim: To evaluate the demographic variables, symptomatology ultrasonographic features and the diagnostic Accuracy, with the help of ultrasonography, in evaluating cystic lesions of liver. Materials and Methods: The study comprised of 50 patients with the clinical symptoms of cystic lesions of liver. They were evaluated with ultrasonography of abdomen where cystic lesions of liver were taken, who needed follow up and interventional procedure. The study was an observational, descriptive hospital based study. Results: 50 patients were evaluated, which comprised equal number of male and female (50%), due to various harmful habits where the Patients had presented with pain and swelling in right hypochondrium. Proper diagnosis cystic lesion of liver was evaluated by ultrasonography for further management. Conclusion: Ultrasound by virtue of non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes in organ is investigation of choice in liver pathology and it can easily detect solid to cystic lesions and characterize the size, shape and extent of lesion.

A Case of Biliary Obstruction Caused by Liver Cyst / 대한소화기학회지

Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient's symptoms improved after simple cyst ablation by sclerotherapy.

Cisto hepático ciliado: relato de um caso / Ciliated hepatic foregut cyst: a case report

Os cistos hepáticos ciliados são estruturas originadas do desenvolvimento embrionário anormal. Eles são raros e benignos, mas que necessitam de tratamento quando sintomáticos ou ao sofrerem malignização. Descrevemos um caso de uma paciente de 32 anos diagnosticada e tratada por videolaparoscopia após apresentar dor abdominal em epigástrio e hipocôndrio direito, náusea e disfagia.

Ciliated hepatic foregut cysts are structures from abnormal embryonic development. They are rare and benign, but need treatment when symptoms or undergo malignant transformation. We described a case report of a 32-years woman diagnosed and surgically treated after abdominal pain in the epigastrium and right hypochondrium, nausea and dysphagia.

Comparison of efficacy between sodium morrhuate and lauromacrogol as sclerosing agents in treatment of hepatic cyst / 临床肝胆病杂志

ObjectiveTo compare the efficacy of sodium morrhuate versus lauromacrogol in the treatment of hepatic cyst. MethodsSeventy-four patients with hepatic cyst who were admitted to our hospital from January 2009 to May 2013 were enrolled as subjects and divided into two groups. After the cystic fluid was drained by percutaneous liver biopsy, sodium morrhuate solution was injected into the cystic cavity for adhesion and sclerosis in 46 patients in group A, and lauromacrogol solution was injected in 28 patients in group B. The incidence rates of pain in patients during and after surgery were compared between the two groups. The follow-up comparison of hepatic cyst recurrence rates within one year after surgery was performed between the two groups. Between-group comparison was performed by χ2 test. ResultsFive patients (10.87%) in group A and two patients (7.14%) in group B had recurrence within one year after treatment. There was no significant difference in recurrence rate between the two groups (χ2=0.283, P＞0.05). The incidence of pain in group A was significantly higher than that in group B (χ2=5.258, P＜0.05). ConclusionWith the same efficacy as sodium morrhuate in the treatment of hepatic cyst, lauromacrogol can be routinely used as a sclerosing agent due to its mild side effects.

Ultrasound-guided lauromacrogol sclerotherapy of simple liver cyst：analysis of its efficacy and safety / 介入放射学杂志

Objective To compare the efficacy and safety of lauromacrogol injection sclerotherapy with ethanol injection sclerotherapy in treating simple liver cysts. Methods A total of 166 patients with simple liver cyst were randomly divided into the lauromacrogol group (study group, n=86) and the absolute alcohol group (control group, n=80). Under ultrasonographic guidance, puncture aspiration of liver cyst was carried out in all patients, which was followed by injection of lauromacrogol for patients in the study group or injection of ethanol for patients in the control group. The therapeutic effect and the side-effect were evaluated. The results were compared between the two groups. Results No serious complications such as bleeding or infection occurred in both groups. During the therapeutic course , 45 patients (56.3%) in the control group felt pain to some degree and 23 patients (28.8%) developed drunk-like symptoms, while no patient in the study group felt any obvious discomfort. One week after sclerotherapy , 20 patients (25%) in the control group complained of distending pain on the right upper abdomen, while only 9 patients (10.5%) in the study group complained of pain, and the difference was statistically significant (χ2= 6.073, P 0.05). Conclusion For the treatment of liver cysts, lauromacrogol injection is safe and effective. Therefore, this technique should be recommended in clinical practice.

Managements of simple liver cysts: ablation therapy versus cyst unroofing

BACKGROUNDS/AIMS: Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy. METHODS: Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1). RESULTS: The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1). CONCLUSIONS: Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.

An Imported Case of Cystic Echinococcosis in the Liver

A 25-year-old Uzbek male presented with right upper abdominal pain for 20 days. On radiologic studies, a huge cystic mass was noticed in the right liver which was suspected as parasitic. The patient received right hepatic segmentectomy (segment 7), and the surgically resected mass was confirmed as cystic echinococcosis (CE), measuring 10.5 cm in its diameter. The inner surface of the cyst was bile-stained. The patient was discharged on the 8th hospital day, and was rechecked 6 months after the surgical intervention without any evidence of recurrence. The present report describes findings of an imported case of CE which represented ultrasound images of the 'ball of wool'.

Transumbilical single-port laparoscopic liver cyst fenestration / 中华消化外科杂志

Objective To determine the feasibility, safety and techniques of transumbilical single-port laparoscopic liver cyst fenestration. Methods From November 2009 to June 2010, four cases of transumbilical single-port laparoscopic liver cyst fenestration were completed through three adjacent 5 mm trocars around the umbilicus. Normal 5 mm laparoscopic instruments and a 5 mm 30° laparoscope were utilized, and the procedures were similar to conventional multi-port laparoscopic liver cyst fenestration. Results All operations were completed successfully, with no conversion to laparotomy or the multi-port laparoscopic procedure. The mean operation time was 38 minutes (25-70 minutes). All patients were discharged at postoperative days 1-3, and no complications or cyst recurrence occurred during hospitalization and follow-up. Conclusions Transumbilical single-port laparoscopic liver cyst fenestration is safe and feasible. It has the advantages of less pain, cosmetic incision and quick recovery, but is technique-demanding.

A Case of Embryonal Sarcoma of the Liver Mimicking a Hydatid Cyst in an Adult

An undifferentiated (embryonal) liver sarcoma (ULS) originates from a primitive mesenchymal cell, with a predilection for childhood and very rare occurrence in adults. We report a case of a ULS that was incidentally found in a 53-year-old female. Our case was initially interpreted as a large hydatid cyst, which was later suspected to be a neoplastic lesion because its size was increasing and a solid portion was newly detected after shrinkage of the cyst following drainage. The patient underwent successful right hepatic lobectomy with complete resection, and is currently disease-free without adjuvant therapy. Although it is difficult to diagnose a hepatic cyst as a ULS due to its rare occurrence in adulthood and lack of specific findings, its possibility should be considered, especially when its size is increasing, because early diagnosis and curative resection are necessary for a favorable outcome.

Quiste hidatídioo hepático caso clínico en la caja nacional de salud - cochabamba / Liver hydatid cyst clinical case in the National Health Fund - Cochabamba

La Hidatidosis Humana es una enfermedad parasitaria de distribución mundial, de localización frecuentemente hepática (50 a 60 % ), única en un 80 %, y múltiple, en los restantes casos,que afecta a pacientes en la edad productiva de la vida y cuyo diagnóstico y tratamiento implican importantes repercusiones socioeconómicas para el sistema de salúd que hacen necesario un plan nacional de actuación que haga posible su erradicación. El conocimiento acabado del ciclo vital del parásito lleva a optimizar el manejo de estos pacientes evitando complicaciones potencialmente mortales. El diagnóstico de la hidatidosis hepática se basa en la clínica del paciente, en las técnicas de imágen, y en los estudios serológicos. El Quiste Hidatídico Hepático puede evolucionar durante varios años en forma asintomática y en muchas oportunidades es un hallazgo por otro cuadro, en la mayoría de los casos la aparición de los síntomas es secundaria a complicaciones del quiste como infección, apertura en un conducto biliar, ruptura, etc. Presentamos un caso de Quiste Hidatídico de localización hepática y sus complicaciones en un joven de 29 años de edad, diagnosticado con ecografía abdominal, complementada con tomografía computada helicoidal y confirmada con serología positiva para el Equinococo y cirugía.

Human Hydatidosys is a parasitic pathology it’s a world widespread distributed, whit a frequently liver localization (50 to 60%), unique in 80% and multiple in the rest of the cases , and affect patients in productive age, which diagnosis and treatment implicate important socio-economic repercussions to the national health system to be necessary a national plan of eradication. The knowledge of the parasite life cycle became to improve the management of these patients avoiding mortal complications. Diagnosis of Hepatic Hydatidosys is based in clinic, image techniques and serology studies. Hieratic Liver Cyst could evolutes into many years asymptomatic, and in many cases is founded by other disease, most of the cases the symptoms appears secondary to cyst complications, as far as infections, opening into a byliar conduct, as brokened, etc. So there we present a 29 years old patient diagnosticated by ecosound, Computer Tomography as complement and confirm whit positive serology to Echinococcus whit finally surgery.

A Case of Simple Hepatic Cyst Complicated by Intracystic Hemorrhage

Simple liver cysts are common and benign lesions, and most of them are detected by ultrasonography (US) or computed tomography (CT) during a medical checkup. Because simple liver cysts are generally asymptomatic, they do not require treatment, although hemorrhage, infection or rupture may occur in rare cases and these cases must receive proper treatment. The diagnosis of simple liver cysts is usually easy because of their typical morphological findings on US or CT. However, when a liver cyst contains hemorrhage or it is inflamed on imaging studies, it is sometimes difficult to differentiate simple hepatic cysts from such conditions as cystadenoma and cystadenocarcinoma. In this report, we describe a case of simple liver cyst that was complicated by intracystic hemorrhage, and this malady was initially diagnosed as biliary cystadenocarcinoma. We successfully treated this lesion by left lateral segmentectomy.

Laparoscopic Treatment of Symptomatic Nonparasitic Liver Cysts

Nonparasitic liver cysts are usually asymptomatic and require treatment when they are symptomatic. Hence, many treatment methods, such as percutaneous aspiration, aspiration followed by injection of sclerosing agents into the cyst, excision of the liver cyst, and hepatic resection have been suggested. Recently, the laparoscopic cholecystectomy has become popular, and this method has been challenged as a treatment for symptomatic nonparasitic liver cysts. To evaluate the feasibility of using and the disadvantages of laparoscopic treatment, we reviewed the medical records of 10 patients with a symptomatic nonparasitic liver cyst who were treated by laparoscopic unroofing at the Department of Surgery, Chungbuk National University Hospital. All patients were diagnosed by USG and abdominal CT. All patients had vague abominal discomfort, abdominal distension, or indigestion. The sizes of the liver cysts varied from 7 cm to 20 cm, and half of them were located in the right lobe, the other half in the left lobe. In 5 patients, the cysts were multiple. The mean operative time was 99.5 minutes, and mean hospital stay was 8 days. The follow up period was from 3 to 37 months. Two patients required a reoperation because of cyst infection and a rapidly growing cyst. Remaining cysts were identified in 4 among 8 patients, but they did not have any symptoms. In conclusion, laparoscopic unroofing is feasible as a first choice for treatment of a symptomatic liver cyst. However, in liver cyst that are located at the dome of right side or in a thickened wall, incomplete unroofing and residual cysts can be anticipated. In this case, we suggest that open cyst excision or unroofing may be better than laparoscopic unroofing.