Contained Rupture of a Large Hydatid Cyst

Clinical Image

Austin J Emergency & Crit Care Med. 2015;2(3): 1019.

Contained Rupture of a Large Hydatid Cyst

Blasco-Navalpotro MA, Flordelís-Lasierra JL* and Chamorro-Borraz N

Intensive Care Unit, Severo Ochoa University Hospital,Spain

*Corresponding author: Flordelís-Lasierra JL, Intensive Care Unit, Severo Ochoa University Hospital, Av. Orellana s/n. Leganés 28911, Madrid, Spain

Received: March 10, 2015; Accepted: March 17, 2015; Published: March 19, 2015

Clinical Image

What is your diagnosis?

A 15 -year-old woman with a history of pollen allergy and consumption of vegetables from a rural area was admitted to our hospital emergency presenting generalized itching and abdominal pain. The blood tests only revealed 17,710 leucocytes/mcl with 13% eosinophils and immunoglobulin E 5000 KUI/L. An abdominal ultrasound and computed tomography were performed. The findings were compatible with a contained rupture of a large liver hydatic cyst (Figures 1,2) [1,2]. She was admitted to intensive care and urgent partial pericystectomy with previous cyst sterilization with hypertonic saline solution was performed [3]. Evolution was satisfactory undergoing treatment with albendazole. The hydatid serology test was positive.

Figure 1: The abdominal ultrasound showed an anechoic (cystic) lesion with membranes floating on the cyst fluid. Within the clinical context referred previously, such image is compatible with a cyst type 3 of International classification of ultrasound images in cystic echinococcosis [1].

    

    
    

    

    Figure 1:  The abdominal ultrasound showed an anechoic (cystic) lesion
with membranes floating on the cyst fluid. Within the clinical context referred
previously, such image is compatible with a cyst type 3 of International
classification of ultrasound images in cystic echinococcosis [1].

Our case reveals that, besides the direct or communicating breakage, the contained rupture of a hydatid cyst should be diagnosed and treated also with priority, in order to avoid open rupture and development of anaphylactic shock [4].

Figure 2: The abdominal computed tomography with intravenous contrast scan revealed a cystic lesion in liver segments V and VI (148X 100 mm) with a curvilinear linear image inside it (arrow) that corresponds with the endocyst detachment.

    

    
    

    

    Figure 2:  The abdominal computed tomography with intravenous contrast
scan revealed a cystic lesion in liver segments V and VI (148X 100 mm) with
a curvilinear linear image inside it (arrow) that corresponds with the endocyst
detachment.

References

  1. WHO Informal Working Group. International clasification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop. 2003; 85: 253-261.
  2. Lewall DB, McCorkell SJ. Rupture of echinococcal Cyst: diagnosis, classification, and clinical implications. Am J Roentgenol. 1986; 146: 391-394.
  3. Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F. Cystic echinococcosis of the liver: A primer for hepatologist. World J Hepatol. 2014; 6: 293-305.
  4. Murali MR, Uyeda JW, Tingpej B. Case 2-2015: A 25-year-old man with abdominal pain, syncope, and hypotension. N Engl J Med. 2015; 372: 265-273.

Citation: Blasco-Navalpotro MA, Flordelís-Lasierra JL and Chamorro-Borraz N. Contained Rupture of a Large Hydatid Cyst. Austin J Emergency & Crit Care Med. 2015;2(3): 1019. ISSN:2380-0879