eMedicine Specialties > Gastroenterology > Liver

Hydatid Cysts: Differential Diagnoses & Workup

Author: Imad S Dandan, MD, Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital
Coauthor(s): Assaad M Soweid, MD, Assistant Professor, Department of Internal Medicine, American University of Beirut, Lebanon; Firass Abiad, MD, Head of Division, General and Laparoscopic Surgery, Specialized Medical Center Hospital, Saudi Arabia
Contributor Information and Disclosures

Updated: Jun 17, 2008

Differential Diagnoses

Abdominal Abscess
Inferior Vena Caval Thrombosis
Acute Liver Failure
Intra-abdominal Sepsis
Biliary Colic
Liver Abscess
Biliary Obstruction
Lung Abscess
Budd-Chiari Syndrome
Portal Hypertension
Cysticercosis
Pyogenic Hepatic Abscesses
Head Trauma
Teratoma, Cystic
Hepatic Carcinoma, Primary
Tuberculosis
Hepatic Cysts
Hydrocephalus
Hypersensitivity Reactions, Immediate

Other Problems to Be Considered

Biliary cirrhosis

Workup

Laboratory Studies

  • The results of routine laboratory blood work are nonspecific. Liver involvement may be reflected in an elevated bilirubin or alkaline phosphatase level. Leukocytosis may suggest infection of the cyst. Eosinophilia is present in 25% of all persons who are infected, while hypogammaglobinemia is present in 30%.
  • Almost every serodiagnostic technique has been evaluated for echinococcosis, with variable results.
    • The indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA) have a sensitivity of 80% overall (90% in hepatic echinococcosis, 40% in pulmonary echinococcosis) and are the initial screening tests of choice.
    • Immunodiffusion and immunoelectrophoresis demonstrate antibodies to antigen 5 and provide specific confirmation of reactivity.
    • The ELISA test is useful in follow-up to detect recurrence.

Imaging Studies

  • Plain films
    • In CE, findings from plain films of the chest, abdomen, or any other involved site are, at best, nonspecific and mostly nonrevealing. A thin rim of calcification delineating a cyst is suggestive of an echinococcal cyst.
    • In AE, results from plain films may be normal.
  • Ultrasound
    • Ultrasonography helps in the diagnosis of hydatid cysts when the daughter cysts and hydatid sand are demonstrated.
    • The accuracy of ultrasound evaluations remains operator-dependent.
  • CT scan
    • CT scan has an accuracy of 98% and the sensitivity to demonstrate the daughter cysts.
    • It is the best test for the differentiation of hydatid from amebic and pyogenic cysts in the liver.
    • In AE, the CT scan findings are sometimes indistinguishable from those of hepatocellular carcinoma.
  • MRI: Images show the cysts adequately, but MRI offers no real advantage over CT scan.

Other Tests

  • Casoni test
    • Historically, an intradermal skin test (Casoni test) was used and had a sensitivity of 70%.
    • It is now largely abandoned because of its low sensitivity, low accuracy, and potential for severe local allergic reaction.

Procedures

  • Endoscopic retrograde cholangiopancreatography: It is both diagnostic and therapeutic in patients with intrabiliary rupture of a hydatid cyst, in whom sphincterotomy can be performed.

More on Hydatid Cysts

Overview: Hydatid Cysts
Differential Diagnoses & Workup: Hydatid Cysts
Treatment & Medication: Hydatid Cysts
Follow-up: Hydatid Cysts
References
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References

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  2. Ochieng'-Mitula PJ, Burt MD. The effects of ivermectin on the hydatid cyst of Echinococcus granulosus after direct injection at laparotomy. J Parasitol. Feb 1996;82(1):155-7. [Medline].

  3. Elsebaie SB, El-Sebae MM, Esmat ME, Nasr MM, Kamel MM. Modified endocystectomy versus pericystectomy in echinococcus granulosus liver cysts: a randomized controlled study, and the role of specific anti-hydatid IgG4 in detection of early recurrence. J Egypt Soc Parasitol. Dec 2006;36(3):993-1006. [Medline].

  4. Filippou D, Tselepis D, Filippou G, Papadopoulos V. Advances in liver echinococcosis: diagnosis and treatment. Clin Gastroenterol Hepatol. Feb 2007;5(2):152-9. [Medline].

  5. Flisser A. Larval cestodes. In: Collier L, Balows A, Sussman M, eds. Topley and Wilson's Microbiology and Microbial Infections. Parasitology. Vol 5. 9th ed. New York, NY: Oxford University Press; 1998:539-60.

  6. Gargouri M, Ben Amor N, Ben Chehida F, Hammou A, Gharbi HA, Ben Cheikh M, et al. Percutaneous treatment of hydatid cysts (Echinococcus granulosus). Cardiovasc Intervent Radiol. Jun-Jul 1990;13(3):169-73. [Medline].

  7. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ. 1996;74(3):231-42. [Medline].

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  10. Liu D, Lightowlers MW, Rickard MD. Evaluation of a monoclonal antibody-based competition ELISA for the diagnosis of human hydatidosis. Parasitology. Apr 1992;104 ( Pt 2):357-61. [Medline].

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  15. Taylor BR, Langer B. Current surgical management of hepatic cyst disease. Adv Surg. 1997;31:127-48. [Medline].

  16. Taylor DH, Morris DL. In vitro culture of Echinococcus multilocularis: protoscolicidal action of praziquantel and albendazole sulphoxide. Trans R Soc Trop Med Hyg. 1988;82(2):265-7. [Medline].

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  18. von Sinner WN. New diagnostic signs in hydatid disease; radiography, ultrasound, CT and MRI correlated to pathology. Eur J Radiol. Mar-Apr 1991;12(2):150-9. [Medline].

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Further Reading

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Keywords

echinococcosis, Echinococcus infestation, hydatid disease, parasitic infestation, tapeworm, zoonotic infection, parasite, Echinococcus granulosus, E granulosus, Echinococcus multilocularis, E multilocularis, Echinococcus vogeli, E vogeli, cystic echinococcosis, CE, alveolar echinococcosis, AE, echinococcal cyst, echinococcal worms, larval cestodes, Platyhelminthes

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Contributor Information and Disclosures

Author

Imad S Dandan, MD, Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital
Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, American Trauma Society, California Medical Association, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Assaad M Soweid, MD, Assistant Professor, Department of Internal Medicine, American University of Beirut, Lebanon
Assaad M Soweid, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Gynecological and Obstetrical Society, and American Medical Association
Disclosure: Nothing to disclose.

Firass Abiad, MD, Head of Division, General and Laparoscopic Surgery, Specialized Medical Center Hospital, Saudi Arabia
Disclosure: Nothing to disclose.

Medical Editor

Ann Ouyang, MBBS, Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Oscar S Brann, MD, FACP, Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group
Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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