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Hydatid Cysts Workup

  • Author: Imad S Dandan, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Aug 19, 2014
 

Laboratory Studies

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  • 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.
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Imaging Studies

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  • 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.
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Other Tests

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  • 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.
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Procedures

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

Imad S Dandan, MD Chief of Trauma Section, Scripps Memorial Hospital La Jolla, California

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, California Medical Association, American Trauma Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Assaad M Soweid, MD, FACG, FASGE Associate Professor of Clinical Medicine, Endosonography and Advanced Therapeutic Endoscopy, Director, Endoscopy-Bronchoscopy Unit, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Lebanon

Assaad M Soweid, MD, FACG, FASGE 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 Medical Association

Disclosure: Nothing to disclose.

Firass Abiad, MD Fellow in Minimally Invasive Surgery, Department of Surgery, University of Tennessee

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

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.

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