First successful puncture, aspiration, injection, and re-aspiration of hydatid cyst in the liver presenting with anaphylactic shock in Korea

Abstract

Hydatid disease is a parasitic infestation caused by the larval form of Echinocococcus. In human, the most commonly affected organs are liver and lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. In Korea, hydatid disease is rare and surgically treated cases have been reported in the Korean literature. However, it is expected to confront this disease sooner or later, because of recent increase in traveling to the endemic area and industrial workers originating from those areas. With this trend, we experienced a case of hydatid cyst of the liver in a male patient from Uzbekistan. This patient was presented with anaphylactic shock combined with hydatid cyst. We successfully treated using ultrasound-guided transhepatic percutaneous drainage [termed puncture, aspiration, injection, and re-aspiration (PAIR)] of the hydatid cyst and concomitant albendazole instead of surgery. In this clinical case report, we describe all the course of the patient and recommend the PAIR as a first choice method for treatment of hepatic hydatid cyst.

Keywords: Hepatic hydatid cyst; PAIR; anaphylactic shock.

Fig. 1

(A) Computed tomography of the abdomen with contrast medium showed a low-density cystic mass, measuring 9×8 cm, in the right hepatic lobe. (B) Ultrasonography of the liver showed a lesion with the characteristic appearance of a hydatid cyst with a hyperechogenic capsule and echogenic material.

Fig. 2

Hydatid sand containing a protoscolex of E. granulosus was observed on microscopic examination (unstained wet preparation, ×40).