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. 2014 Nov-Dec;34(6):508-16.
doi: 10.5144/0256-4947.2014.508.

Clinical characterization of unusual cystic echinococcosis in southern part of Turkey

Atlgan Tolga Akcam, Abdullah Ulku, Ismail Soner Koltas  1 , Volkan Izol, Omer Sunkar Bicer, Emine Kilicbagir, Gurhan Sakman, Hakan Poyrazoglu, Tahsin Erman, Ibrahim Atilla Aridogan, Cem Kaan Parsak, Mehmet Inal, Serdar Iskit
Affiliations

Clinical characterization of unusual cystic echinococcosis in southern part of Turkey

Atlgan Tolga Akcam et al. Ann Saudi Med. 2014 Nov-Dec.

Abstract

Background and objectives: The incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients.

Design and settings: A retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcal Hospital.

Patients and methods: Among the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis.

Results: Of 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases.

Conclusion: CE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

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Figures

Figure 1
Figure 1
Large retroperitoneal cystic echinococcosis seen on upper abdominal CT image.
Figure 2
Figure 2
A) CE occupying left frontal lobe of brain. B) CE of spinal cord.
Figure 3
Figure 3
The tomographic image of CE of spleen.
Figure 4
Figure 4
The tomographic image of CE of right kidney.
Figure 5
Figure 5
The tomographic imaging of CE on heart.
Figure 6
Figure 6
Osseos CE of left iliac spine.
Figure 7
Figure 7
MRCP imaging of CE of pancreas.
Figure 8
Figure 8
The tomographic image of bilateral adnexal CE.
Figure 9
Figure 9
CE on the right neck originated from the right lobe of the thyroid.
Figure 10
Figure 10
Ultrasonographic demonstration of breast CE.
See this image and copyright information in PMC

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