Chapter 51: Liver- Hydatid Liver Cyst

Question 1

What is it?

Answer 1

Usually a right lobe cyst filled with Echinococcus granulosus

Question 2

What are the risk factors?

Answer 2

1. Travel
2. exposure to (carriers):
   
   • dogs
   • sheep
   • cattle

Question 3

What are the signs/symptoms?

Answer 3

RUQ abdominal pain

jaundice

RUQ mass

Question 4

How is the diagnosis made?

Answer 4

1. Indirect hemagglutination antibody test (serologic testing)
2. Casoni skin test
3. ultrasound
4. CT scan
5. radiographic imaging

Question 5

What are the findings on AXR?

Answer 5

Possible calcified outline of cyst

Question 6

What are the major risks?

Answer 6

Erosion into the pleural cavity pericardial sac, or biliary tree

Rupture into the peritoneal cavity causing fatal anaphylaxis

Question 7

What is the risk of surgical removal of echinococcal (hydatid)cysts?

Answer 7

Rupture or leakage of cyst contents into the abdomen may cause a fatal anaphylactic reaction

Question 8

When should percutaneous drainage be performed?

Answer 8

Never; may cause leaking into the peritoneal cavity and anaphylaxis

Question 9

What is the treatment?

Answer 9

Mebendazole, followed by surgical resection;

large cysts can be drained and then injected with toxic irrigant (scoliocide) into the cyst unless aspirate is bilious(which means there is a biliary connection) followed by cyst removal

Question 10

Which toxic irrigations are used?

Answer 10

Hypertonic saline, ethanol, or cetrimide