Rare presentations and Complications of Hepatic Hydatid Cysts

Transcription

1 Rare presentations and Complications of Hepatic Hydatid Cysts Poster No.: C-1926 Congress: ECR 2012 Type: Educational Exhibit Authors: A. Kapoor, A. Arora, N. GUPTA, S. K. Puri ; Delhi/IN, NEW DELHI, DE/IN, , DE/IN, New Delhi/IN Keywords: Abdomen, Biliary Tract / Gallbladder, Liver, CT, MR, Ultrasound, Complications, Infection, Parasites, Tropical diseases DOI: /ecr2012/C-1926 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Learning objectives To illustrate thevaried presentation and complications of hepatic hydatid cysts. In this poster we will review the various complications that can be caused by the hydatid cysts which makes it essential to treat them at the earliest. Background Echinococcosis is a zoonotic disease caused by the larval stage of Echinococcus granulosus. The disease is a significant health problem especially in Eastern Europe, Mediterranean countries, South America and Far East including India(1). The infection results in development of hydatid cysts most commonly in the liver (60-70%) and the lungs (20-30%)(2). Although benign, the disease may have a variable clinical course and maybe complicated by secondary infection, biliary or peritoneal rupture, the consequences of which may be life threatening. Thus treatment is required in most cases. Imaging findings OR Procedure details Hydatid cysts may not present with their classical features at times making it difficult to give a conclusive diagnosis on imaging alone. They may mimic an amoebic liver abscess or simple hepatic cyst. Fig 1 They may be large with a diameter of > 10 cm or may present as multiple and recurrent cysts. (Fig 2). Hydatid cyst may rupture into biliary tree involving the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts(fig 3) or rarely the gallbladder (Fig 4). Rupture can be occult or frank. A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event. Patient may present with acute hydatid cholecystitis. Spontaneous rupture of hepatic cyst may lead to subcapsular or loculated perihepatic collection (Fig 3). Large cysts may cause compression of PV (Fig 5), causing atrophy of the affected lobe. These may damage the confluence of the hepatic ducts or cause ductal compression (Fig6) causing deep obstructive jaundice. In the frank rupture daughter vesicles and fragmented membranes escape into the biliary tree causing obstructive jaundice, acute cholangitis or septicemia. Acute pancreatitis and acute cholecystitis caused by hydatid material are also known entities. Cystogram Page 2 of 12

3 may be done in cases of occult rupture prior to interventions like PAIR to confirm biliary communication (Fig 7). Hepatic hydatid cysts may rupture transdiaphragmatically into pleural space or lung parenchyma (Fig 8) to form communication with bronchus. Spontaneous rupture may also lead to peritoneal hydatidosis(fig 9). Images for this section: Fig. 1: A large segment VIII hydatid cyst without any calcification or internal membranes mimicking simple hepatic cyst Page 3 of 12

4 Fig. 2: A calcified hydatid cyst in left lobe along with multiple smaller hydatid cysts in right lobe showing perilesional edema and confusing with cholangiolar abscess. Page 4 of 12

5 Fig. 3: Complications of ruptured hydatid cyst: Axial CT image showing dilated bile ducts with linear hyperdense membranes(red arrow)representing germinative membranes. A thick walled cystic lesion showing wall enhancement is seen in the right lobe(blue arrow). Subcapsular fluid collection showing wall enhancement is also seen. Page 5 of 12

6 Fig. 4: Complications of ruptured hydatid cyst: Thick walled hydatid cystic within the gall bladder(red arrow). Membranes occluding the CBD causing bilateral IHBRD (Yellow arrow) Page 6 of 12

7 Fig. 5: A right lobe hydatid cyst causing compression of the right branch of portal vein(red arrow) Page 7 of 12

8 Fig. 6: Dilated ducts (Arrows) caused by compression of the confluence by the large hydatid cyst. Page 8 of 12

9 Fig. 7: Cystogram of the hydatid cyst prior to PAIR demonstrationg biliary communication. Page 9 of 12

10 Fig. 8: Coronal CT MPR image showing transdiaphragmatic rupture of hepatic hydatid cyst. Page 10 of 12

11 Fig. 9: Longitudinal USG in pelvic region showing multip;le thin walled cyst showing distal acoustic enhancement. Page 11 of 12

12 Conclusion A good knowledge of atypical presentation and complications of hepatic hydatid cysts is essential to come to a correct diagnosis. This helps in avoiding any intervention which could lead to serious complications or fatal outcome. Personal Information Dr Abhay Kumar Kapoor, Dr Ankur Arora, Dr Nishant Gupta, Dr Sunil Kumar Puri 3 1 Senior Resident, GB Pant Hospital, New Delhi, India 2 Assistant Professor, ILBS, New Delhi, India 3 Profesor & Head of Deptt, GB Pant Hospital, New Delhi, India References 1 Djuricic SM, Grebeldinger S, Kafka DI. Cystic echinococcosis in children-the seventeenyear experience of two large medical centers in Serbia. Parasitol Int 2010; 59(2): Morris D, Richards K. Hydatid disease. Oxford: Butterworth-Heinemann; R Kumar, S N Reddy and S Thulkar: Intrabiliary rupture of hydatid cyst: diagnosis with MRI and hepatobiliary isotope study. The British Journal of Radiology, 75 (2002), S. Bhat, R.T. Kamble, P. Sundaram and J.M. Joshi: Transdiaphragmatic Extension of Hepatic Hydatid Cyst. Indian J Chest Dis Allied Sci 2002; 44 : Page 12 of 12