Cystic echinococcosis: A neglected disease at usual and unusual locations

Abstract

Echinococcus granulosus causes a zoonotic infection called cystic echinococcosis (CE) or more commonly known as hydatid disease. Although the two most common locations of hydatid cyst are liver and lung, it may also appear in other parts of the body. Clinical presentation of the hydatid disease depends on the site and size of the lesion. A retrospective study was done in Medical College and Hospital, Kolkata, from January 2012 to June 2014, to find the site of involvement, distribution, clinical features, history of contact, mode of presentation, laboratory diagnosis, and treatment modalities of the cases of hydatid cyst. The cases were identified by radiological and laboratory methods, the data were entered in Excel spreadsheet, and analysis was done. Among the 21 cases of hydatid cyst included in the study, solitary hepatic involvement was seen in 11 (52.38%), pulmonary involvement in 4 (19%), and 6 (28.71%) were in unusual locations such as liver cyst extending as retroperitoneal, omental cyst, choledochal cyst, splenic cyst, and in hepatorenal pouch. History of contact with dog was seen in 15 (71.43%). All the patients were treated with surgery and albendazole and were discharged in healthy condition. CE may be present in usual and unusual locations with a lot of variations in the clinical features. Hence, proper radiological and laboratory diagnosis is required for accurate diagnosis and appropriate management of these cases.

Keywords: Albendazole; cystic echinococcosis; hydatid cyst; liver cyst; lung cyst; surgery.

Figure 1

Computerized tomography scan shows a large hydatid cyst with a noncalcified, high-attenuation wall in the right hepatic lobe

Figure 2

Computerized tomographya scan shows hydatid cyst with a noncalcified wall in the spleen

Figure 3

Chest X-ray showing a dense homogeneous radiopaque opacity involving the right lower zone with obliteration of costophrenic angle

Figure 4

Computerized tomography scan showing a dense homogeneous mass involving the right lower zone of lung

Figure 5

Computerized tomography scan shows a hydatid cyst with a noncalcified wall in the right lower lobe of lung (lateral view)

Figure 6

Management of the abdominal cysts

Figure 7

Wet mount of centrifuged hydatid cyst fluid shows scolex and hydatid sand