Sonographic management of complicated cystic echinococcosis

• Published in: Journal of ultrasound 2007-12, Vol.10 (4), p.179-185
• Main Authors: Caremani, M., Lapini, L., Tacconi, D., Giorni, P., Corradini, S., Giaccherini, R.
• Format: Article
• Language: English
• Subjects: Complications; Cystic echinococcosis; Diagnosis; Treatment; Ultrasound
• ISSN: 1971-3495; 1876-7931
• DOI: 10.1016/j.jus.2007.09.005

In this survey we evaluated the usefulness of ultrasonography (US) in the diagnosis, and in the treatment of complicated hydatid cysts. From June 1985 to June 2004, 221 patients with 294 hydatid cysts were examined. Twenty patients (9.0%) presented 22 complicated cysts (7.4%): 9 with infection, 5 ruptured into the bile ducts, 2 bilomas, 2 cysto-pleural fistulas, 2 allergic reactions, 1 rupture into the peritoneum and 1 intrasplenic hematoma. In all cases, US yielded a specific or suspected diagnosis, also in complications affecting non-hepatic sites, confirmed by computed tomography (CT), endoscopic papillotomy or percutaneous US-guided sampling. All patients with complicated cystic echinococcosis were treated with Albendazole 800 mg/day for at least 3 months. In addition to this therapy, 12 underwent US-guided drainage (9 infected cysts, 2 bilomas, 2 cysto-pleural fistulas, 1 intrasplenic hematoma); of these patients 3 subsequently underwent surgery because US-guided treatment was ineffective. Five patients were treated with perendoscopic sphincterotomy for obstruction of the bile passages, while 3 patients received only medical therapy. Medical, echoguided and surgical treatments led to resolution of the complications and complete remission of the parasitic pathology in 19/20 patients (95%) and in 21/22 cysts (95.4%). There was partial remission in 1 case only. The therapy did not cause major complications and the results were confirmed during follow-up lasting from 5 months to 15 years (mean time 3 years). This study shows that the incidence of complications of hydatid cysts is low and that correct echographic management allows a rapid diagnosis and optimization of treatment in most cases. Gli autori valutano in questo lavoro l'utilità dell'ecografia nella diagnosi e nel trattamento ecoguidato delle cisti idatidee complicate. Dal giugno 1985 al giugno 2004 gli autori hanno seguito 221 pazienti affetti da 294 cisti idatidee. 20 pazienti (9,0%) presentavano 22 cisti complicate (7,4%): 9 erano infettate, 5 rotte nelle vie biliari, 2 bilomi, 2 fistole cisto-pleuriche, 2 reazioni allergiche, 1 rotta in peritoneo ed 1 ematoma intrasplenico. In tutti i casi l'ecografia permise di sospettare la diagnosi, anche per le complicanze extraepatiche, che venivano confermate dalla TC, dalla papillosfinterotomia perendoscopica, o dai prelievi ecoguidati. Tutti i pazienti affetti da cisti idatidee complicate furono trattati con 800 mg/die di albendazolo, per almeno 3 mes