Ettorre Giuseppe Maria, Vennarecci Giovanni, Santoro Roberto, Laurenzi Andrea, Ceribelli Cecilia, Di Cintio Antonio, Rizzi Elisa Busi, Antonini Mario
Division of Surgical Oncology and Liver Transplantation, San Camillo Hospital, POIT San Camillo-INMI Lazzaro Spallanzani, Cir,ne Gianicolense N° 187, 00100, Rome, Italy.
J Med Case Rep. 2012 Sep 13;6:298. doi: 10.1186/1752-1947-6-298.
Hydatid disease is a helminthic anthropozoonosis with worldwide distribution due to the close associations among sheep, dogs, and humans. It can occur almost anywhere in the body with a variety of imaging features, which may change according to the growth stage, associated complications, and affected tissues. A definitive diagnosis requires a combination of imaging, serologic and immunologic studies. Ultrasonography, computed tomography and magnetic resonance imaging are highly accurate in detecting a hepatic hydatid cyst. However, hepatic hydatid cysts in an unusual location and/or of an unusual dimension, with atypical imaging findings, may complicate the differential diagnosis. Surgical treatment remains the best treatment.
We describe an unusual case of a giant hydatid cyst, with exophytic growth from the right lobe of the liver of a 55-year-old Egyptian man. The cyst was strongly adhered to his ipsilateral kidney, which was displaced in a downwards and anterior direction, close to his abdominal wall, simulating a retroperitoneal origin. This atypical growth raised doubts about the most appropriate surgical approach. Magnetic resonance imaging easily clarified the origin of the cyst as our patient's liver, allowing accurate surgical planning.
Rarely, hydatid cysts can reach an extremely large size without any additional symptoms. Giant cysts need radical therapy because they might lead to perforation and anaphylaxis in some patients. Magnetic resonance imaging is very useful in the study of hydatid disease because of its capacity to allow a large field of view, multiplanar acquisition, and high contrast resolution. In some unusual hepatic presentations, magnetic resonance imaging can be used to determine the correct anatomical relationships.
包虫病是一种蠕虫类人畜共患病，由于绵羊、狗和人类之间的密切关联，在全球范围内均有分布。它几乎可发生于身体的任何部位，具有多种影像学特征，这些特征可能会根据生长阶段、相关并发症及受累组织而发生变化。明确诊断需要结合影像学、血清学和免疫学检查。超声、计算机断层扫描和磁共振成像在检测肝包虫囊肿方面具有很高的准确性。然而，位于不寻常位置和/或具有不寻常大小、伴有非典型影像学表现的肝包虫囊肿可能会使鉴别诊断变得复杂。手术治疗仍然是最佳治疗方法。
我们描述了一例不寻常的巨大包虫囊肿病例，该囊肿自一名55岁埃及男性肝脏右叶向外生长。囊肿与同侧肾脏紧密粘连，导致肾脏向下和向前移位，靠近腹壁，类似腹膜后起源。这种非典型生长对最合适的手术方法提出了疑问。磁共振成像轻松明确了囊肿起源于患者的肝脏，从而得以进行准确的手术规划。
罕见情况下，包虫囊肿可长得极大而无任何其他症状。巨大囊肿需要进行根治性治疗，因为在某些患者中它们可能导致穿孔和过敏反应。磁共振成像在包虫病研究中非常有用，因为它能够提供大视野、多平面采集以及高对比度分辨率。在一些不寻常的肝脏表现中，可以使用磁共振成像来确定正确的解剖关系。
