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Case Reports
. 2013 Oct;2(4):225-7.
doi: 10.4103/2303-9027.121246.

Diagnosis of hydatid cyto-biliary disease by intraductal ultrasound (with video)

Randa Akel  1 , Walid Faraj  2 , Ali Haydar  3 , Omar Masri  1 , Nadim El-Majzoub  4 , Mohamad J Khalife  2 , Mohamad A Eloubeidi  5
Affiliations
Case Reports

Diagnosis of hydatid cyto-biliary disease by intraductal ultrasound (with video)

Randa Akel et al. Endosc Ultrasound. 2013 Oct.

Abstract

Hydatid disease is one of the relatively common infections in the Middle Eastern countries. It is seen in areas where dogs are used to raise livestock. In humans, the majority of Echinococcus cysts tends to develop in the liver (70%) and is asymptomatic. The two most common complications of hydatid cysts are abscess formation and rupture. Furthermore, in 5-25% of patients, rupture occurs into the biliary tract and patients may present with cholangitis, jaundice, abscess, or bilio-cutaneous fistula after surgery. Intraductal ultrasound (IDUS) is reportedly superior to conventional endoscopic ultrasound for the depiction of bile duct obstruction owing to its additional capability of providing higher resolution images due to the use of higher frequency transducers. Unfortunately IDUS is rarely used, possibly due to the limited availability of appropriate IDUS equipment, cost of the procedure and interventional endoscopists trained in its interpretation. IDUS with wire-guided, thin-caliber, high-frequency probes is a promising imaging modality, yet no previous reports discuss its usefulness in hydatid disease investigation. We hereby present the first report of biliary hydatid disease being diagnosed by IDUS.

Keywords: biliary disease; hydatid disease; intraductal ultrasound.

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Figures

Figure 1
Figure 1
Curved reformatted computed tomography with intravenous contrast showing the hydatid cyst (arrow head) communicating with the dilated biliary tree (curved arrow) and dense material in the proximal hepatic duct indicating the daughtercyst (solid arrow)
Figure 2
Figure 2
Endoscopic retrograde cholangiopancreatography showing contrast within dilated biliary tree (solid arrow) and daughter cyst within proximal hepatic duct (curved arrow)
Figure 3
Figure 3
Intraductal ultrasound revealed a hyperechoic filling defect most consistent with hydatid disease and not infiltrating tumor thus ruling out cholangiocarcinoma
Figure 4
Figure 4
One month fol low-up endoscopic retrograde cholangiopancreatography showing no dilation of biliary tree and no evidence of filling defect within hepatic duct
See this image and copyright information in PMC

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