Wednesday, August 5, 2009

Hydatid cyst of Liver

Multiphasic study of 55 year old male patient non contrast image shows well defined fluid attenuating lesion seen in the segment 8 of liver with rim calcification. The lesion does not show enhancement on arterial and venous phase. The findings are consistent with calcified hydatid cyst. (Type 5).

The liver is the commonest organ to be involved by the hydatid disease. The hydatid cyst can attain very large size before causing symptoms or may be incidentally dectedted early on investigation.

Types of hydatid cyst accodring to Gjarbi's classification bases on uSG appearance:
Type 1 : Pure fluid collection.
Type 2 : Fluid collection with a split wall.
Type 3 : Fluid collection with daughter cysts.
Type 4 : Heterogenous echopattern.
Type 5: Completely calcified lesion.

Preffered management is combination of Albendazone and PAIR techniqe - Puncture, Aspiration, Injection and Re-aspiration (PAIR).

Pracedure : Percutaneous drainage is performed under aseptic conditions with continuous sonographic guidance and intensive monitoring to treat any complications. Using a transhepatic approach, the cyst punctured by a 20-gauge needle and cyst contents aspirated rapidly. After aspiration, the cyst should be filled with a near-equal volume of 95% ethanol which will be left in the cavity for 20 min. Finally the cyst is reaspirated, irrigated and left partially filled with sterile 0.9% saline. Before and after injection of 95% ethanol, cyst fluid should be sent immediately for cytological and microbiological examination. Staining with neutral red is indicated in a viable cyst, while staining with methylene blue and eosin indicated in a non-viable cyst. Percutaneous drainage will be successful if the endocyst separated from the pericyst and if the reaspirated fluid shows a non-viable cyst. If not, percutaneous drainage was repeated at the same sitting to obtain success. After percutaneous drainage had been performed, all patients should be given albendazole 10 mg/kg body weight for 6 weeks. Othre treatment option is surgery which includes morbidity and mortality.

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