Another alternative in the treatment of hepatic cystic echinococcosis (Part one)
Until recently, the treatment of liver echinococcosis disease has been considered only surgical. In fact, the spontaneous finding of fully calcified liver cysts indicates that after several stages, the disease has "healed" spontaneously even without any special medical treatment.
Absolutely in this publication, the passive stance in the diagnosis of the disease is not prioritized, nor is the special role of surgery in the treatment of this pathology denied, but by knowing well the development process and the stages of disease evolution, we can successfully use in some cases, less invasive alternatives that are equally successful as the known surgical treatments.
However, of particular interest for very good curative results, remain the attempts to set the diagnosis as soon as possible, in the early stages of the disease evolution.
Ultrasounds are the best, fastest, and least expensive method to diagnose hydatid cysts as well as to follow the progress after treatment.
We are introducing one of the classifications, the one accepted by the World Health Organization, for hepatic hydatid cysts as well as possible treatment alternatives depending on the evolutionary stages of the disease.
Stages according to the WHO classification. Echographic characteristics:
| CL | General cystic lesions, of still undetermined nature. |
| CE1 | Completely watery parasitic cyst, which can be distinguished with difficulty from
a simple cyst. (Active). |
| CE2 | Watery parasitic cyst with daughter cysts inside the mother cyst. (Active). |
| CE3a | Parasitic cyst with water and membrane detachment. (Cyst suffering from doubtful activity) |
| CE3b | Solid parasitic cyst but with daughter cysts inside it. (Cyst suffering from doubtful activity) |
| CE4 | Solid parasitic cyst. (Inactive). |
| CE5 | Calcified parasitic cysts. (Inactive). (1). |
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Fig. 1. Voluminous hydatid cyst of the first type with visible own membrane in Echo as well as with posteriorly stratified echogenic material. (CE1).
Echographic management of hydatid cysts
M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani**
* U.O. Infectious Diseases - S. Donato Hospital - Arezzo; ** Section of Hematology - S. Donato Hospital – Arezzo. Page 142.
Italian Journal of Ultrasound 2005; 8(2): 141-149
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Fig. 2. The study of a liver cystic lesion with a 10 MHz probe
Highlighting a proprietary membrane with a thickness of 4 mm with
A triple aspect, typical for the parasitic membrane of a
Hydatid cyst. (CE1).
Echographic management of hydatid cysts
M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani**
* U.O. Infectious Diseases - S. Donato Hospital - Arezzo; ** Section of Hematology - S. Donato Hospital – Arezzo. Page 146.
Italian Journal of Ultrasound 2005; 8(2): 141-149
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The first and second type cysts are evolving cysts with a tendency to grow, while those of the third and fourth type, represent the suffering stage and the involution of the hydatid cyst.
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Fig. 3. Hydatid cyst of the right lobe of the liver with a wheel aspect
with daughter cysts inside. (CE2).
Echographic management of hydatid cysts
M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani**
* U.O. Infectious Diseases - S. Donato Hospital - Arezzo; ** Section of Hematology - S. Donato Hospital
Page 142. Italian Journal of Ultrasound 2005; 8(2): 141-149
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Fig. 4. Hydatid cyst of the liver treated with alcoholization under Ultrasound with the aspect of a swimming flower. (CE3).
Echographic management of hydatid cysts
M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani**
* U.O. Infectious Diseases - S. Donato Hospital - Arezzo; ** Section of Hematology - S. Donato Hospital
S. Donato - Arezzo. Page 143: Italian Journal of Ultrasound 2005; 8(2): 141-149
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Fig. 5. A large lesion of the third hepatic segment with the aspect of a blade.
Fourth type hydatid cyst. (CE4) .
Echographic management of hydatid cysts
M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani**
* U.O. Infectious Diseases - S. Donato Hospital - Arezzo; ** Section of Hematology - S. Donato Hospital
S. Donato - Arezzo. Page 143: Italian Journal of Ultrasound 2005; 8(2): 141-149
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Fig. 6. Subcostal right oblique ultrasound section. Several lesions can be distinguished from which:
- One hypoechoic in the 6th segment.
- Another hyperechoic in the 7th segment.
- And two calcified lesions in the 5th and 6th segments.
These are indicators of hydatid cysts in different stages of evolution: (Type CE4 and CE5).
Echographic management of hydatid cysts
M. Caremani*, L. Lapini*, D. Tacconi*, P. Giorni*, A. Caremani**
* U.O. Infectious Diseases - S. Donato Hospital - Arezzo; ** Section of Hematology - S. Donato Hospital
S. Donato - Arezzo. Page 143: Italian Journal of Ultrasound 2005; 8(2): 141-149
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