Hydatid Cysts Workup
- Author: Imad S Dandan, MD; Chief Editor: BS Anand, MD more...
See the list below:
- 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.
See the list below:
- 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.
- 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.
See the list below:
- 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.
See the list below:
- Endoscopic retrograde cholangiopancreatography: It is both diagnostic and therapeutic in patients with intrabiliary rupture of a hydatid cyst, in whom sphincterotomy can be performed.
Wang K, Zhang X, Jin Z, Ma H, Teng Z, Wang L. Modelling and analysis of the transmission of echinococcosis with application to Xinjiang Uygur Autonomous Region of China. J Theor Biol. 2013 May 10. [Medline].
Torgerson PR. The emergence of echinococcosis in central Asia. Parasitology. 2013 May 10. 1-7. [Medline].
Moldovan R, Neghina AM, Calma CL, Marincu I, Neghina R. Human cystic echinococcosis in two south-western and central-western Romanian counties: A 7-year epidemiological and clinical overview. Acta Trop. 2012 Jan. 121(1):26-9. [Medline].
Kapan S, Turhan AN, Kalayci MU, Alis H, Aygun E. Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg. 2008 May. 12(5):867-71. [Medline].
Ochieng'-Mitula PJ, Burt MD. The effects of ivermectin on the hydatid cyst of Echinococcus granulosus after direct injection at laparotomy. J Parasitol. 1996 Feb. 82(1):155-7. [Medline].
Mamarajabov S, Kodera Y, Karimov S, Abdiev S, Sabirov B, Krotov N, et al. Surgical Alternatives for Hepatic Hydatid Disease. Hepatogastroenterology. 2011 Oct 12. 58(112):[Medline].
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. 2006 Dec. 36(3):993-1006. [Medline].
Filippou D, Tselepis D, Filippou G, Papadopoulos V. Advances in liver echinococcosis: diagnosis and treatment. Clin Gastroenterol Hepatol. 2007 Feb. 5(2):152-9. [Medline].
Flisser A. Larval cestodes. Collier L, Balows A, Sussman M, eds. Topley and Wilson's Microbiology and Microbial Infections. Parasitology. 9th ed. New York, NY: Oxford University Press; 1998. Vol 5: 539-60.
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. 1990 Jun-Jul. 13(3):169-73. [Medline].
Heath DD. Immunology of echinococcus infections. Thompson R, Lymbery AJ, eds. Echinococcus and Hydatid Disease. Wallingford, Oxon: CAB International; 1995. 183-200.
Kjossev KT, Losanoff JE. Hydatid cysts of the liver: TN(R)C classification. Int Surg. 1998 Oct-Dec. 83(4):311-3. [Medline].
Liu D, Lightowlers MW, Rickard MD. Evaluation of a monoclonal antibody-based competition ELISA for the diagnosis of human hydatidosis. Parasitology. 1992 Apr. 104 ( Pt 2):357-61. [Medline].
Liu YH, Wang XG, Chen YT, Yao YQ. Computer tomography of liver in alveolar echinococcosis treated with albendazole. Trans R Soc Trop Med Hyg. 1993 May-Jun. 87(3):319-21. [Medline].
Polo JR, Garcia-Sabrido JL. Sclerosing cholangitis associated with hydatid liver disease. Arch Surg. 1989 May. 124(5):637. [Medline].
Schröder R, Robotti G. New aspects in the management of alveolar echinococcosis involving the liver. World J Surg. 1986 Dec. 10(6):968-73. [Medline].
Tan A, Yakut M, Kaymakçioglu N, Ozerhan IH, Cetiner S, Akdeniz A. The results of surgical treatment and percutaneous drainage of hepatic hydatid disease. Int Surg. 1998 Oct-Dec. 83(4):314-6. [Medline].
Taylor BR, Langer B. Current surgical management of hepatic cyst disease. Adv Surg. 1997. 31:127-48. [Medline].
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].
Todorov T, Mechkov G, Vutova K, Georgiev P, Lazarova I, Tonchev Z, et al. Factors influencing the response to chemotherapy in human cystic echinococcosis. Bull World Health Organ. 1992. 70(3):347-58. [Medline].
von Sinner WN. New diagnostic signs in hydatid disease; radiography, ultrasound, CT and MRI correlated to pathology. Eur J Radiol. 1991 Mar-Apr. 12(2):150-9. [Medline].
Williams JF, Perez Esandi MV, Oriol R. Evaluation of purified lipoprotein antigens of Echinococcus granulosus in the immunodiagnosis of human infection. Am J Trop Med Hyg. 1971 Jul. 20(4):575-9. [Medline].