Hydatid

diseases.DR/ ABD

ALLAH NAZEER.

MD. Brain.

Orbit.

Chest.Heart.

Diaphragm.

Liver.

Spleen.

Kidneys.

Adrenal gland.

Pancreas.

Peritoneum. Pelvis.

Bones.

Musculoskeletal.

Introduction: Hydatid disease (also known as hydatidosis or echinococcosis) is caused by a tapeworm which infects dogs, dingoes and foxes. At its intermediate stage, it forms cysts in the internal organs, especially livers and lungs, of a number of animals, including humans. In humans, the disease is so serious that it requires surgery for treatment. Hydatid disease also causes losses in livestock with the downgrading of edible meat by-products because of the presence of the hydatid cysts. Control of hydatid disease involves the elimination of the hydatid tapeworm from dogs. By carrying out the recommended control measures, the infection of dogs with the tapeworm can be prevented, and the spread of the disease to other animals, including humans, reduced. With better control of hydatid disease in domestic livestock and dogs, it is the hydatid cycle that occurs in wildlife which is becoming relatively more important as a threat to human health.

Signs and symptoms.In the human manifestation of the disease, E. granulosus, E. multilocularis, E. oligarthrus and E. vogeliare localized in the liver (in 75% of cases), the lungs (in 5-15% of cases) and other organs in the body such as the spleen, brain, heart and kidneys (in 10-20% of cases). In the patients who are infected with E. granulosus and therefore have cystic echinococcosis, the disease develops as a slow-growing mass in the body. These slow-growing masses, often called cysts, are also found in patients that are infected with alveolar and polycystic echinococcosis. The cysts found in those with cystic echinococcosis are usually filled with a clear fluid called hydatid fluid, are spherical and typically consist of one compartment and are usually only found in one area of the body. While the cysts found in those with alveolar and polycystic echinococcosis are similar to those found in those with cystic echinococcosis, the alveolar and polycystic echinococcosis cysts usually have multiple compartments and have infiltrative as opposed to expansive growth.

Symptoms are primarily of cholestatic jaundice (about a third) and epigastric pain (about a third), fatigue, weight loss, hepatosplenomegaly and altered LFTs.Distant metastases are possible, and involvement of other organs (for example, in the lung, brain, and bone) occurs in as many as 13% of the patients.Disease in the lung causes cough, hemoptysis, dyspnea and pyrexia.Disease in the brain causes raised intracranial pressure and can cause epilepsy.Disease in the vertebrae can lead to compression of the spinal cord, causing paraplegia. In the long bones it may cause fractures and deformity.

Prevention of hydatid disease in endemic areasDog owners should practice good hygiene when handling their animals.It is important to wash the hands after handling dogs.Avoid contact with dog faeces.Prevent dogs from soiling the immediate environment.Prevent dogs from roaming or having access to raw sheep meat or viscera.All sheep carcasses should be disposed of correctly and immediately.All dogs, especially those in rural endemic areas should be treated at six-weekly intervals with a wormer containing praziquantel. Vegetables, salads and fruit should be thoroughly washed before consumption.

Cerebral hydatid disease:

Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic.

left parieto-occipital hydatid disease.

Multiple left parietal hydatid cyst.

Left temporo-parietal hydatid cyst.

Right parietal hydatid cyst.

Multiple daughter cysts.Single daughter cyst insideUnilocular cyst.

Orbital hydatid cyst.

Hydatid cysts rarely appear in the orbital cavity without the involvement of the other organs. Most of them are situated in the superolateral and superomedial angles of the orbit. Inferiorly located cysts are very uncommon.

Right retro-orbital hydatid cyst.

Left orbital hydatid cysts.

Hydatid disease of the lung.

The lung is the second most common site of involvement with echinococcosis granulosus in adults after the liver (10-30% of cases), and the most common site in children. The coexistence of liver and lung disease is present in only 6% of patients

Radiographic features:X-Ray chest PA, show calcified cyst at the lower or upper lung zone.Chest CT-scanChest CT scan features include:multiple or solitary cystic lesion (most common)diameter of 1-20 cmunilateral or bilateralpredominantly found in the lower lobes

X-Ray show hydatid disease of the left lung.

Right lower lung hydatid cyst.

Right lower lung hydatid cyst.

Hydatid cyst with air-fluid level.

Cardiac echinococcosis rarely mimics acute coronary syndromes. The authors found only six reports in the literature describing cardiac echinococcosis mimicking acute myocardial ischemia

Cardiac HC at the inter-ventricular septum and right pulmonary artery.

Cardiac hydatid cyst.

Giant Cardiac Hydatid Cyst.

Hydatid cysts located in the left hemidiaphragm, which is protruding intercostally into subcutaneous space and preperitoneal extension

Primary Giant Hydatid Cyst of the Diaphragm

Hydatid Disease of the liver. Hydatid disease involves the liver in approximately 75% of cases

The right lobe is the most frequently involved portion of the liver. Once in the human liver, cysts grow to 1 cm during the first 6 months and 2–3 cm annually thereafter, depending on host tissue resistance.

X-Ray show hydatid disease of the right liver lobe.

Hydatid disease of right lobe.

Hydatid disease of right lobe with calcification.

Hydatid disease of liver.

Hydatid disease of liver with multiple daughter cyst.

Hydatid disease with daughter cyst and water lily sign.

Hydatid cyst in right lobe of the liver.

Hydatid Disease of the Spleen

Splenic involvement in hydatid disease is uncommon, representing less than 2% of all human infestations by Echinococcus .

Splenic hydatid cyst.

Hydatid disease of liver and spleen.

CT scan showing hydatid cyst in spleen.

Several splenic hydatid disease.

Splenic hydatid disease.

Primary hydatid cyst of kidney. Kidney involvement in echinococcosis is extremely rare, constituting only 2-3% of all cases. Primary involvement of the kidney without the involvement of the liver and lungs is even more rare.

Hydatid disease of the right kidney.

Hydatid disease of left kidney and liver.

Hydatid disease of left kidney.

Hydatid disease of adrenal gland.

Primary hydatid disease in the adrenal gland.

Hydatid cyst of the adrenal gland is rare; this entity is found in only 7% of all adrenal cysts. It occurs in cases of disseminated infection by Echinococcus granulosus beyond the hepatic and pulmonary filters. The infection is usually asymptomatic. When symptoms are present, most are related to local visceral compression.

Primary Adrenal Hydatid Cyst.

Left adrenal gland HC.Right adrenal gland HC.

Pancreatic hydatid cyst with pancreatitis.

Primary hydatid cysts of the pancreas.Pancreatic involvement by hydatid disease is uncommon. Establishing a precise diagnosis may be difficult because the presenting symptoms and findings of investigations may be similar to other more commonly encountered cystic lesions of the pancreas

Hydatid disease of the pancreatic body and tail.

Peritoneal hydatidosisPeritoneal hydatidosis can be primary or more frequently secondary to hydatid cysts in the liver or rarely in the spleen. Primary peritoneal hydatidosis is rare. The mechanism of peritoneal infestation in such cases is not clear. Dissemination via lymphatics or systemic circulation has been implicated as a possible route.Secondary peritoneal hydatidosis almost always from hepatic hydatid disease, and related to seeding from spontaneous rupture of hepatic cyst into the peritoneum or spillage of cyst fluid during surgery. In both instances, depending on the patients immune response, this sudden release of hydatid antigens into the peritoneal cavity can result in anaphlaxis. If this does not occur, and viable organisms are present, then multiple cysts can develop.

Peritoneal and hepatic hydatid disease with major duct obstruction.

Intra and retro-peritoneal hydatid disease.

Primary peritoneal hydatidosis.

GIANT MULTIPLE INTRA-ABDOMINAL HYDATID CYSTS.

Disseminated intraperitoneal hydatid disease.

Primary pelvic hydatid cyst.Primary pelvic hydatid cyst is a rare entity. Pelvic hydatid cysts usually present with pressure symptoms involving adjacent organs (bladder and rectum usually).

Primary pelvic hydatid cyst.

Right ovarian hydatid cyst. Retro-vesical hydatid cyst.

Isolated retrovesical hydatid cysts.

Retro-vesical and seminal vesicle hydatid cyst.

Primary isolated echinococcal cyst of the seminal vesicle.

Bone hydatid disease.Bone hydatid disease lacks a typical clinical appearance and image characteristics on x ray or CT are similar to those of tuberculosis, metastases and giant cell tumour or bone cysts. However, MRI does show distinctive diagnostic features of bone hydatid disease, especially in the spine.

Spinal hydatid cyst.

Multicystic lesion with multiple daughter cysts in the para-spinal with extension to the para-spinal space.

Soft tissue hydatid cyst.