Fístula biliobronquial secundaria a quiste hidatídico hepático en tránsito torácico: caso clínico / Bronchobiliary fistula secondary to hepatic hydatid cyst in thoracic transit: clinical case

Resumen Introducción: En un quiste hidatídico hepático pueden ocurrir una serie de complicaciones de diversa gravedad. Una es el tránsito hepatotorácico (THT), que es el compromiso simultáneo de hígado, diafragma y pulmón secundario a migración de un quiste hidatídico hepático. Objetivo: Presentar una complicación de baja incidencia de un quiste hidatídico hepático como lo es el THT con fistula biliobronquial y posterior resolución quirúrgica. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Paciente con diagnóstico de quiste hidatídico en tránsito hepatotorácico con fístula biliobronquial fue sometida a toracotomía, resección en cuña del pulmón incluyendo bronquios comunicantes con el quiste. Paciente presenta evolución clínica e imagenológica favorable. Discusión: Se discuten formas de presentación, complicaciones de la evolución, grados de progresión y ubicaciones anatómicas frecuentes. Se hace énfasis en rol de la clínica e imagenología para diagnóstico y lo controversial del manejo. Conclusión: Tratamiento quirúrgico dependerá de localización de la lesión, estado del quiste, tamaño y experiencia del equipo quirúrgico, siendo una quistectomía con tratamiento de los trayectos fistulosos una buena alternativa.

Introduction: A variety of severe complications can occur in a hepatic hydatid cyst. One of them is the transit from liver to thorax through the diaphragm (HTT). Aim: To present a low impact complication of a hepatic hydatid cyst such as HTT with bronchobiliary fistula and subsequent surgical procedure. Materials and Method: Clinical, imaging, and photographic record of the clinical event. Results: A patient with a diagnosis of hydatid cyst in hepatothoracic transit with bronchobiliary fistula underwent thoracotomy with a wedge resection of the lung, including a cyst-bronchial communication. The patient presents good clinical and imaging evolution. Discussion: Forms of presentation, evolutionary complications, stages of progression, and frequent anatomical locations are discussed. Emphasis is made on the role of the clinical examination and imaging tests for diagnosis and controversial management. Conclusión: Surgical treatment will depend on location of the lesion, experience of the surgical team, condition and size of the cyst, being a cystectomy with the treatment of the fistulous tracts a good alternative.

Ecografía para la evaluación inicial de pacientes con sospecha de hidatidosis hepática / Ultrasound for the initial evaluation of patients with suspected hepatic hydatidosis

La hidatidosis o equinococosis quística es una infección endémica en varias regiones de Argentina. Su forma más frecuente, la hidatidosis hepática, suele ser asintomática por largos periodos de tiempo y, de presentar síntomas, los mismos suelen ser solapados, inespecíficos y crónicos. Por este motivo, los métodos complementarios de diagnóstico resultan indispensables en la valoración de estos pacientes. Entre ellos, la ecografía continúa siendo el método de elección con el que iniciar la evaluación ante la sospecha de hidatidosis hepática; otros métodos, como la serología, la tomografía computada o la resonancia magnética, pueden resultar de utilidad en casos específicos y siempre contextualizados por la clínica, epidemiología, y los hallazgos ecográficos. (AU)

Hydatidosis or cystic echinococcosis is an endemic infection in several regions of Argentina. Its most frequent form, hepatic hydatidosis, is usually asymptomatic for long periods of time and, if symptoms occur, they are usually overlapping, non-specific and chronic. For this reason, complementary diagnostic methods are essential in the evaluation of these patients. Among them, ultrasound remains the method of choice to initiate the evaluation of suspected hepatic hydatidosis; other methods, such as serology, computed tomography or magnetic resonance imaging, may be useful in specific cases and always contextualised by the clinical, epidemiology and ultrasound findings. (AU)

Traumatic rupture of liver hydatid cysts into the peritoneal cavity of an 11-year-old boy: a case report from Iran

Abstract This is the first published case report of an 11-year-old patient with a rupture of a liver hydatid cyst (HC) into the peritoneal cavity after an abdominal trauma in Iran. The disease was diagnosed using focused abdominal sonography for trauma. To date, no cases of traumatic ruptures of liver HCs in children have been reported in Iran. In the endemic regions of the world, where patients suffer from a history of trauma and constant abdominal symptoms or anaphylactic shock, early diagnosis of HC is crucial as it may disseminate to other organs. The condition needs conservative surgery and follow-up.

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.

Daughter cysts in a cyst of the liver: hepatic echinococcosis

No abstract available.

Hepatic hydatid cyst rupture and anaphylaxis after a fall.

A 15-year-old boy presented to the emergency unit complaining of dyspnea, urticaria and vomiting developed after he fell down when he was playing football. Abdominal ultrasound showed a ruptured hydatid cyst in the right lobe of the liver which was of communicating type. Echinococcus granulosus serologic tests were positive. Medical treatment was started immediately. One week later, follow up US showed no changes in the findings. Intrabdominal fluid leakage was not detected. Patient's general condition showed improvement and he was discharged 12 days later.

Diagnosis of abdominal hydatid cyst disease: the role of ultrasound and ultrasound-guided fine needle aspiration cytology

To retrospectively analyze the role of ultrasound [US] imaging and US-guided fine needle aspiration cytology in the diagnosis and management of abdominal hydatid cyst disease [HCD]. Subjects and The medical records of 55 diagnosed cases of HCD seen between January 1986 and December 2000 at Mubarak Al-Kabeer Hospital and Al-Amiri Hospital in Kuwait were reviewed for demographic and clinical data, including radiology and serology. The US findings of the patients were classified into four types as follows: type I: single or multiple well-defined cysts, with or without detached or collapsed wall and with or without echogenic contents; type II: single or multiple cysts with peripheral cysts, with or without echogenic contents; type III: solid or semisolid lesions, and type IV: cysts with calcified walls. The overall accuracy of US in the diagnosis of HCD was 80% [44/55 cases]. US examination was suggestive of HCD type I, 16/19 [84%], type II, 21/23 [91%], type III, 3/8 [38%], and type IV, 4/5 [80%]. For the 11 remaining undiagnosed cases, US was useful for localizing the lesions for US-guided fine needle aspiration cytology. It established the diagnosis in all the 11 cases, without precipitating complications. US alone was valuable for diagnosing and localizing HCD in the abdomen except for solid-type lesions. US-guided fine needle aspiration cytology was useful in localizing and establishing the diagnosis of HCD in the cases where US alone was ineffective