splenic hydatid cyst

Splenic hydatid infection is a rare form of hydatid disease, and isolated splenic involvement is even less common.

For a general discussion, and for links to other system-specific manifestations, please refer to the article on hydatid disease.

Epidemiology

Splenic hydatid disease has been reported to constitute up to 4% of cases of abdominal hydatid disease .

Clinical presentation

Splenic hydatid cysts are generally asymptomatic. When the cyst reaches an advanced size, the patient presents with a painful mass in the left hypochondrium .

Symptoms are nonspecific and include:

• abdominal pain
• enlarged spleen
• fever

Pathology

Splenic hydatid cysts are usually solitary. As the hydatic cyst increases in size, it may lead to compression of the hilar vessels of the spleen, resulting in pericystic splenic atrophy. Eventually, the cyst may completely replace the splenic parenchyma. Chronic pericystic inflammation may cause adhesion with adjacent organs or even fistulization between the cyst and nearby organs such as the stomach, pancreas, left colon, left kidney or bronchus .

Etiology

• systemic dissemination
• intraperitoneal spread from a ruptured hepatic hydatid cyst 
• retrograde spread from the liver to the spleen via the hepatic portal and splenic veins in portal hypertension 

Radiographic features

Imaging findings are similar to those of hepatic hydatid disease and range from purely cystic lesions to a completely solid appearance .

Ultrasonography and CT are the most valuable imaging techniques for the diagnosis and evaluation of focal splenic diseases .

Treatment and prognosis

Management options include surgery but owing to the risk of spontaneous or traumatic rupture, splenic hydatid cysts are usually treated surgically with a total or partial splenectomy. Albendazole therapy is the mainstay of treatment in the postoperative follow-up period .

Complications

• secondary infection is rare and usually occurs by haematogenous spread
• cyst rupture
• anaphylactic shock

Differential diagnosis

The differential diagnosis for splenic hydatid cysts includes other splenic cystic lesions:

• splenic epidermoid cysts
• splenic pseudocysts
• splenic abscesses
• splenic hematomas
• cystic neoplasms of the spleen 
• intrasplenic pancreatic pseudocyst

Siehe auch:

• verkalkte Milzläsionen
• zystische Läsionen der Milz
• verkalkte Milzzyste
• portale Hypertension
• Lymphangiom Milz
• Echinococcus Leber
• splenic epidermoidcyst
• splenic hydatid disease with peritoneal seeding
• Echinococcuszyste Pankreas
• fokale Milzläsionen und Anomalien

und weiter:

• Echinokokkose
• focal splenic calcifications
• Infektionen der Milz