rupturierte Echinokokkuszyste
Complicated
hepatic hydatid disease.. Large HC with structural deformity, disruption and presence of a fluid collection in the subphrenic space adjacent to the ruptured HC.
Complications
of hepatic echinococcosis: multimodality imaging approach. A 66-year-old woman with diffuse abdominal echinococcosis. Coronal reformatted CT image shows peritoneal dissemination of hydatid cysts (arrows), due to direct rupture of the original liver cysts and compression of the right diaphragm by one of the hepatic hydatid cyst (arrowhead)
Rupture of an
echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis. Sagittal reformations (left side) shows multiple cyst in different evolutive phases.
Rupture of an
echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis. Collapsed cyst with hyperattenuating rim at the left flank.
Complications
of hepatic echinococcosis: multimodality imaging approach. A 50-year-old woman with contained rupture hydatid cyst. Axial contrast-enhanced CT on portal venous phase shows hepatic hydatid cyst (arrow) with hyperattenuating serpentine linear membrane within the cyst (arrowhead)
Complications
of hepatic echinococcosis: multimodality imaging approach. A 65-year-old woman with contained rupture hydatid cyst due to response to therapy. Contrast-enhanced CT on portal venous phase shows the serpentine linear membrane within an almost completely calcified cyst
Complications
of hepatic echinococcosis: multimodality imaging approach. A 48-year-old man with hydatid liver cyst complicated with communicating rupture. a, b US images show a focal anechoic liver lesion with internal septa and hyperechoic peripheral rim, with some posterior shadows, diffuse biliary dilatation and endoluminal hyperechoic foci (arrowhead) into the common bile duct with no posterior acoustic shadows. Axial CT scan in the portal venous phase (c) and MR image on T2-weighted sequence (d) confirm the presence of a liver cyst and diffuse biliary dilatation, with material into the biliary tree (arrow). These features are consistent with progressive migration of the hydatid sand and membranes from the hilar confluence to the common bile duct
Complications
of hepatic echinococcosis: multimodality imaging approach. An 85-year-old woman with hydatid cysto-colic fistulization. Axial contrast-enhanced CT image (a) and sagittal reformatted CT image (b) on portal venous phase demonstrate a large hepatic hydatid cyst with peripheral wall calcifications and air-fluid level (arrow), with frank communication (arrowhead) with the right colon
Complications
of hepatic echinococcosis: multimodality imaging approach. A 70-year-old man with echinococcosis. Axial CT image on portal venous phase demonstrates a pararectal homogeneous cystic lesion (arrow), showing internal septa and partial wall calcification, in a patient with hepatic hydatid cysts (not shown in this image)
Complications
of hepatic echinococcosis: multimodality imaging approach. A 72-year-old man with communicating rupture. Radiographic image performed during ERCP demonstrates a linear calcified opacity (arrowhead)—representing a hepatic hydatid cyst—and intrahepatic bile duct dilatation (white arrow). The catheter (black arrow) introduced in biliary tree enters directly into the cyst, documenting the cysto-biliary fistula
Hydatid
disease • Ruptured renal hydatid cyst - Ganzer Fall bei Radiopaedia
Complications
of hepatic echinococcosis: multimodality imaging approach. A 65-year-old woman with cysto-biliary rupture. a Radiographic image performed during ERCP procedure shows multiple filling defects into the common bile duct (arrow), representing hydatid membranes. b Endoscopic image of the same patient shows hydatid membranes extraction
Complications
of hepatic echinococcosis: multimodality imaging approach. A 54-year-old man with air content within a hepatic hydatid cyst. Coronal reformatted CT image on portal venous phase shows air bubbles (arrowhead) within a unilocular calcified hydatid cyst. This finding was suggestive of occult cysto-biliary communication, which was later confirmed at surgery
Complications
of hepatic echinococcosis: multimodality imaging approach. A 66-year-old man with multiple fat-containing hydatid cysts in the liver. a Axial gradient-echo in-phase T1-weighted MR image shows multiple high signal intensity foci (arrows) within hepatic hydatid cyst. b Axial gradient-echo opposed-phase T1-weighted MR image shows macroscopic fat within the same lesions, a finding confirmed by chemical shift artifact and signal cancelation (arrows) surrounding the lipid pure component
Complications
of hepatic echinococcosis: multimodality imaging approach. A 48-year-old man with communicating rupture. MR images on T2-weighted (a) and T1-weighted gradient echo (b) sequences demonstrate endoluminal biliary content (arrows), hypointense and hyperintense on respective images, at the hilar biliary confluence. On MRCP image (c), the endoluminal obstructive biliary content leads to loss of signal intensity (arrow) from the hilar biliary confluence to the common hepatic duct, while the common bile duct is patent
Complications
of hepatic echinococcosis: multimodality imaging approach. A 57-year-old man with communicating rupture and superinfection of liver hydatid cyst. Axial contrast-enhanced CT images at different levels (a, b) show multiple intrahepatic abscesses (arrowheads), adjacent to a hydatid cystic lesion with peripheral wall calcifications and intracystic air content. Note a calcified fragment of wall cyst within the right intrahepatic bile duct (white arrow), which migrates into the common bile duct (black arrow) at 10-days CT follow-up (c)
Hydatid
disease • Ruptured splenic hydatid cyst - Ganzer Fall bei Radiopaedia
Management of
abdomen hydatidosis after rupture of a hydatid splenic cyst: a case report. CT scan demonstrating floating membrane in the splenic cyst and multiple cysts in the peritoneal cavity.
Rupture of an
echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis. Coronal reformation
rupturierte Echinokokkuszyste
Echinokokkose Radiopaedia • CC-by-nc-sa 3.0 • de
Hydatid cysts result from infection by the Echinococcus tapeworm species and can result in cyst formation anywhere in the body.
Epidemiology
Cystic echinococcosis has a worldwide geographical distribution. The Mediterranean basin is an important endemic area .
Pathology
There are two main species of the Echinococcus tapeworm :
- Echinococcus granulosus
- more common
- pastoral: the dog is the main host; most common form
- sylvatic: the wolf is the main host
- Echinococcus alveolaris/multilocularis
- less common but more invasive
- fox is the main host
Definitive hosts are carnivores (e.g. dogs, foxes, cats), and the intermediate hosts are most commonly sheep. Humans are accidental hosts, and the infection occurs by ingesting food contaminated with Echinococcus eggs .
Cyst structure
The cysts usually have three components :
- pericyst: composed of inflammatory tissue of host origin
- exocyst
- endocyst: scolices (the larval stage of the parasite) and the laminated membrane are produced here
Cyst classification
Based on morphology the cyst can be classified into four different types :
- type I: simple cyst with no internal architecture
- type II: cyst with daughter cyst(s) and matrix
- type IIa: round daughter cysts at the periphery
- type IIb: larger, irregularly shaped daughter cysts occupying almost the entire volume of the mother cyst
- type IIc: oval masses with scattered calcifications and occasional daughter cysts
- type III: calcified cyst (dead cyst)
- type IV: complicated cyst, e.g. ruptured cyst
For hepatic hydatid infection on ultrasound also refer to World Health Organization 2001 classification of hepatic hydatid cysts.
Location
- hepatic hydatid infection: most common organ (76% of cases)
- pulmonary hydatid infection: second most common organ (15% of cases)
- splenic hydatid infection: third most common organ (5% of cases)
- cerebral hydatid infection
- spinal hydatid infection
- retroperitoneal hydatid infection
- renal hydatid infection
- musculoskeletal hydatid infection
- mediastinal hydatid infection (very rare)
Markers
Radiographic features
A chest film or other plain films can be the first diagnostic modality when echinococcosis is suspected, depending on clinical indications.
CT and MRI imaging are indicated when considering surgical treatment, particularly in regions like the brain, spine, and locations inaccessible for conventional radiography or ultrasound, or in case of diagnostic uncertainty.
Ultrasound
The Gharbi ultrasound classification consists of five stages:
- stage 1: homogeneously hypoechogenic cystic thin-walled lesion
- stage 2: septated cystic lesion
- stage 3: cystic lesion with daughter lesions
- stage 4: pseudo-tumor lesion
- stage 5: calcified or partially calcified lesion (inactive cyst)
Treatment and prognosis
Four treatment options are currently available :
- surgical excision
- PAIR (Puncture, Aspiration, Injection of protoscolicidal agent and Reaspiration)
- chemotherapy with an anti-helminthic agent (albendazole, mebendazole)
- watch and wait for inactive and silent cysts
Treatment outcomes were improved when surgery or PAIR was combined with benzimidazole given before and after surgery . Regarding medical management, higher scolicidal and anti-cystic activity was seen in combination therapy with albendazole plus praziquantel and was more likely to result in cure or improvement .
Siehe auch:
Assoziationen und Differentialdiagnosen zu rupturierte Echinokokkuszyste:
