Hepatic Cystic Echinococcosis
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Jentry B. Lloyd
A woman presented to her family physician in summer 2012 with worsening right upper quadrant pain and nausea, unrelated to food intake, of 3 months duration. Additional history included a weight loss of 8 lb over the past month and no recent travel. The patient reported that she had immigrated to the United States from Uzbekistan in 1995 and that she was exposed to feral dogs in her homeland.
Physical examination revealed no jaundice or palpable Murphy sign. Computed tomography of the abdomen (not pictured) revealed 2 complex lesions measuring 53 mm × 59 mm × 61 mm and 34 mm × 39 mm × 43 mm, with invasion to the right hepatic duct and vein. The cystic lesions were morphologically associated with thin internal septae and peripheral calcifications, consistent with hepatic cysts caused by Echinococcus granulosus.1 Enzyme-linked immunosorbent assay findings were positive for serologic echinococcus IgG; however, a follow-up immunoblot test performed at the Centers for Disease Control and Prevention did not confirm these findings.2 Fine-needle aspiration biopsy revealed protoscolices (independent pathologic confirmation). The patient was prescribed albendazole prophylactic therapy (400 mg twice daily) to minimize the risk of secondary echinococcosis. Six months later, the patient was referred for surgical resection, which she tolerated well without complications.3 The excised and transected inked cyst containing viable protoscolices is shown in the image.
Acknowledgment
We thank William R. Finch, MD, for his invaluable suggestions during the preparation of this article.
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Financial Disclosures: None reported.
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Support: None reported.
References
1 Czermak BV Akhan O Hiemetzberger R et al. . Echinococcosis of the liver. Abdom Imaging.2008;33(2):133-143.10.1007/s00261-007-9331-0Search in Google Scholar PubMed
2 Zhang W Wen H Li J Lin R McManus DP . Immunology and immunodiagnosis of cystic echinococcosis: an update[published online December 25, 2011]. Clin Dev Immunol.2012;2012:101895. doi:10.1155/2012/101895.10.1155/2012/101895Search in Google Scholar PubMed PubMed Central
3 Khuroo MS Wani MA Javid G et al. . Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med.1997;337(13):881-887. doi:10.1056/NEJM199709253371303.10.1056/NEJM199709253371303Search in Google Scholar PubMed
© 2014 The American Osteopathic Association
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Articles in the same Issue
- In My View
- Shorter Training Is No Solution for Building the Primary Care Physician Workforce
- A New Model for Educating Our Nation's Primary Care Physicians
- Letters
- Effect of Inpatient Electroencephalography on Clinical Decision Making: EEG Is More Valuable Than Findings Suggest
- Effect of Inpatient Electroencephalography on Clinical Decision Making: EEG Is More Valuable Than Findings Suggest
- Response
- AOA Communication
- Official Call (Reprint)
- Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
- Original Contribution
- Effect of Osteopathic Manipulative Treatment on Middle Ear Effusion Following Acute Otitis Media in Young Children: A Pilot Study
- Osteopathic Manipulative Treatment for Inpatients With Pulmonary Exacerbations of Cystic Fibrosis: Effects on Spirometry Findings and Patient Assessments of Breathing, Anxiety, and Pain
- Assessing Palpation Thresholds of Osteopathic Medical Students Using Static Models of the Lumbar Spine
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- Effectiveness of Osteopathic Manipulative Therapy for Managing Symptoms of Irritable Bowel Syndrome: A Systematic Review
- Medical Education
- Predictive Relationship of Osteopathic Manual Medicine Grades and COMLEX-USA Level 1 Total Scores and Osteopathic Principles and Practice Subscores
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