Liver alveolar hydatid cyst diagnosed patient with right intrahepatic biliary tract obstruction: A case report with special emphasis on radiological features

Öz

Hepatic alveolar echinococcosis is a rare parasitic disease caused by Echinococcosis multilocularis. The disease is diagnosed by a combination of serological tests, radiological modalities and histology of needle biopsy specimens. In this case, we present magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) findings in a patient with right intrahepatic biliary tract obstruction due hepatic alveolar echinococcosis. A 66-year-old female patient who was diagnosed as liver alveolar hydatid cyst at the external university hospital in her anamnesis presented for evaluation of right upper-quadrant abdominal pain. MRI and MRCP were taken to patient. Lesion with hyper-intense and iso-intense components were observed in T2A images with a diameter of approximately 70x65 mm, length of 76 mm, heterogeneous intensities, no definite boundaries in liver segment 6-7 on MRI and MRCP. Continuation of right intrahepatic bile ducts was not observed due secondary to pressure of lesion. The lumen was slightly prominent in the traceable segment of approximately 7 mm. In lesion’s peripheral segments, intrahepatic bile ducts were dilated in segment 6-7 due secondary pressure of lesion. The intrahepatic main bile ducts were normally wide on the left. The diameter of the choledochus was measured approximately 9 mm at its most prominent location and is normally expanded. The gallbladder was hydropic and had a transverse diameter of approximately 48 mm. There was no calculi or matter occupying the lumen. Alveolar echinococcosis lesions mimic slow-growing tumors of the liver parenchyma that tend to infiltrate adjacent structures, especially the portal hilum, hepatic veins, inferior vena cava, and biliary system, and spread to other organs by means of hematogenous dissemination. These lesions may be misdiagnosed as malignant neoplasms if the diagnosis is based on clinical features and imaging findings of local invasion and regional or distant metastases, without serologic testing. If left untreated, alveolar echinococcosis is eventually fatal. Effective treatment options include benzimidazole therapy and surgical resection or liver transplantation.

Anahtar Kelimeler

• Cystic Echinococcosis,Magnetic Resonance cholangiopancreatography,Liver,Biliary tract obstruction

Alveolar kist hidatik tanılı hastada gelişen sağ intrahepatik safra yollarında obstrüksiyon: Radyolojik özelliklerinin vurgulandığı olgu sunumu

Öz

Hepatik elveolar ekinokokkozis Echinococcus multilocularis’e bağlı gelişen nadir bir parazitik hastalık olup tanı serolojik, radyolojik ve histopatolojik değerlendirme ile konur. Bu vakada alveolar ekinokokkozis tanılı hastada gelişen sağ intrehepatik safra yollarında obstrüksiyonun manyetik rezonans görüntüleme (MRG) ve manyetik rezonans kolanjiopankreotografi (MRKP) bulgularını sunduk. Hikayesinde üniversite hastanesinde karaciğer alveolar hidatik kist tanısı olduğunu öğrendiğimiz 66 yaşında kadın hasta sağ üst kadran ağrısı ile kliniğe başvurdu. Hastaya MRG ve MRKP tetkikleri çekildi. Karaciğer segment 6-7 de yaklaşık 70x65 mm çaplarında, 76 mm uzunluğunda, heterojen intensitede, sınırları net seçilemeyen, T2A görüntülerde hiperintens ve izointens komponentleri bulunan alan izlendi. Sağda intrahepatik safra yolları devamlılığı lezyon basısına sekonder izlenmedi. İzlenebilen distal yaklaşık 7 mm'lik segmentte lümeni hafif belirgindi. Lezyon periferik kesimlerinde segment 6-7'de intrahepatik safra yolları dilate görünümde olup intrahepatik ana safra kanalları solda normal genişlikte saptandı. Koledok çapı en belirgin yerinde yaklaşık 9 mm ölçülmüş olup normalden genişti. Safra kesesi hidropik görünümde olup transvers çapı yaklaşık 48 mm ölçülmüştür, lümeninde yer kaplayan lezyon yoktu. Alveoler ekinokokkoz lezyonları, komşu yapılara, özellikle portal hiluma, hepatik venlere, inferior vena kava ve safra sistemine infiltre olan ve hematojen yayılım yoluyla diğer organlara yayılan, karaciğer parankiminin yavaş büyüyen tümörlerini taklit eder. Bu lezyonlar, serolojik testler olmaksızın, lokal invazyon ve bölgesel veya uzak metastazların klinik özelliklerine ve görüntüleme bulgularına dayanarak, malign neoplazmalar olarak yanlış teşhis edilebilir. Tedavi edilmezse, alveoler ekinokokkozun sonunda ölümcül olur. Etkin tedavi seçenekleri arasında benzimidazol tedavisi ve cerrahi rezeksiyon veya karaciğer transplantasyonu yer alır.

Anahtar Kelimeler

• Kistik ekinokokkozis,Manyetik rezonans kolanjiopankreotografi,Karaciğer,Safra yolu obstrüksiyonu

Kaynakça

1. 1. Haider HH, Nishida S, Selvaggi G, Levi D, Tekin A, Moon JI, Tzakis AG. Alveolar Echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant. 2008;22:664‐7.
2. 2. Koc M. The investigation of clinical and radiological findings of hepatic alveolar cyst hydatid disease. Annals of Medical Research. 2018;25(4)768-71.
3. 3. Biava FM, Dao A, Fortier B. Laboratory diagnosis of cystic hydatic disease. World J Surg. 2001;25:10-14.
4. 4. Chautems R, Bubler L, Gold B, Chilcott M, Morel P, Mentba G. Long term results after complete or incomplete surgical resection of liver hydatid disease. Swiss Med Wkly. 2003;133:258-62.
5. 5. Turkyilmaz Z, Sonmez K, Karabulut R, Demirogullari B, Gol H, Basaklar AC, et al. Conservative surgery for treatment of hydatidcysts in children. World J Surg. 2004;28:597-601.
6. 6. Kurul IC, Topcu S, Altinok T, Yazici U, Tastepe I, Kaya S, et al. Onestage operation for hydatid disease of lung and liver: principles oftreatment. J Thorac Cardiovasc Surg. 2002;124:1212-5.
7. 7. Altintaş N. Past to present: echinococcosis in Turkey. Acta Tropica. 2003;85:105-12.
8. 8. Ciftci N, Ates F, Turkdagi H, Findik D. Evaluation of seropositivity of patients with cystic echinococcosis. Genel Tıp Derg. 2017;27(3):91-4.

9. 9. Beggs I. The radiology of hydatid disease. AJR Am J Roentgenol. 1985;145(3):639-48.
10. 10. Radford AJ. Hydatid Disease. In: Weatherall DJ, Ledingham JGG, Warell DA, eds.Oxford textbook of medicine. Oxford: Oxford University Press. 1982:5.442-4.
11. 11. Catalano OA, Sahani DV, Forcione DG, et al. Biliary Infections: Spectrum of Imaging Findings and Management. Radiographics. 2009;29:2059-80.
12. 12. Czermak BV, Akhan O, Hiemetzberger R, et al. Echinococcosis of the liver. Abdom Imaging. 2008;33:133-43.
13. 13. Yanık F, Karamustafaoğlu YK, Yoruk Y. Dıagnostıc dılemma in discrimination between hydatıd cyst and Tumor, for two cases. Namık Kemal Medical Journal. 2017;5(1):44-9.