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Liu H, Xie Y, An X, Xu D, Cai S, Chu C, Liu G. Advances in Novel Diagnostic Techniques for Alveolar Echinococcosis. Diagnostics (Basel) 2025; 15:585. [PMID: 40075832 PMCID: PMC11898896 DOI: 10.3390/diagnostics15050585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 02/10/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
Alveolar echinococcosis (AE), caused by the larval stage of the tapeworm Echinococcus multilocularis, is a serious parasitic disease that presents significant health risks and challenges for both patients and healthcare systems. Accurate and timely diagnosis is essential for effective management and improved patient outcomes. This review summarizes the latest diagnostic methods for AE, focusing on serological tests and imaging techniques such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). Each imaging modality has its strengths and limitations in detecting and characterizing AE lesions, such as their location, size, and invasiveness. US is often the first-line method due to its non-invasiveness and cost-effectiveness, but it may have limitations in assessing complex lesions. CT provides detailed anatomical information and is particularly useful for assessing bone involvement and calcification. MRI, with its excellent soft tissue contrast, is superior for delineating the extent of AE lesions and their relationship to adjacent structures. PET/CT combines functional and morphological imaging to provide insights into the metabolic activity of lesions, which is valuable for monitoring treatment response and detecting recurrence. Overall, this review emphasizes the importance of a multifaceted diagnostic approach that combines serological and imaging techniques for accurate and early AE diagnosis, which is crucial for effective management and improved patient outcomes.
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Affiliation(s)
- Huanhuan Liu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, Fujian Engineering Research Center of Molecular Theranostic Technology, School of Public Health, Xiamen University, Xiamen 361102, China
- Department of Nuclear Medicine, School of Public Health, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China
| | - Yijia Xie
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, Fujian Engineering Research Center of Molecular Theranostic Technology, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Xiaoyu An
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, Fujian Engineering Research Center of Molecular Theranostic Technology, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Dazhuang Xu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, Fujian Engineering Research Center of Molecular Theranostic Technology, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Shundong Cai
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, Fujian Engineering Research Center of Molecular Theranostic Technology, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Chengchao Chu
- Xiamen University Affiliated Xiamen Eye Center, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Gang Liu
- State Key Laboratory of Vaccines for Infectious Diseases, Center for Molecular Imaging and Translational Medicine, Xiang An Biomedicine Laboratory, National Innovation Platform for Industry-Education Integration in Vaccine Research, Fujian Engineering Research Center of Molecular Theranostic Technology, School of Public Health, Xiamen University, Xiamen 361102, China
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Aydin S, Irgul B, Memis KB, Kızılgoz V, Kantarci M. Characteristics of the imaging diagnosis of alveolar echinococcosis. World J Gastrointest Surg 2024; 16:2748-2754. [PMID: 39351560 PMCID: PMC11438814 DOI: 10.4240/wjgs.v16.i9.2748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/06/2024] [Accepted: 06/24/2024] [Indexed: 09/18/2024] Open
Abstract
Alveolar echinococcosis (AE) primarily manifests in the liver and exhibits characteristics resembling those of slow-growing malignant tumours. Untreated Echinococcus multilocularis infection can be lethal. By infiltrating the vascular systems, biliary tracts, and the hilum of the liver, it might lead to various problems. Due to its ability to infiltrate neighbouring tissues or metastasize to distant organs, AE can often be mistaken for malignancies. We present a concise overview of the epidemiological and pathophysiological characteristics of AE, as well as the clinical manifestations of the disease. This article primarily examines the imaging characteristics of AE using various imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging, diffusion-weighted imaging, and virtual non-enhanced dual-energy CT. We additionally examined the contribution of radiography in the diagnosis, treatment, and monitoring of the condition.
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Affiliation(s)
- Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Baris Irgul
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Kemal Bugra Memis
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Volkan Kızılgoz
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24100, Türkiye
| | - Mecit Kantarci
- Department of Radiology, Erzurum Ataturk University, Erzurum 25000, Türkiye
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Autier B, Manuel C, Lundstroem-Stadelmann B, Girard JP, Gottstein B, Gangneux JP, Samson M, Robert-Gangneux F, Dion S. Endogenous IL-33 Accelerates Metacestode Growth during Late-Stage Alveolar Echinococcosis. Microbiol Spectr 2023; 11:e0423922. [PMID: 36786637 PMCID: PMC10101030 DOI: 10.1128/spectrum.04239-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023] Open
Abstract
During the course of the infectious disease alveolar echinococcosis (AE), the larval stage of Echinococcus multilocularis develops in the liver, where an initial Th1/Th17 immune response may allow its elimination in resistant individuals. In patients susceptible to infection and disease, the Th2 response initiates later, inducing tolerance to the parasite. The role of interleukin 33 (IL-33), an alarmin released during necrosis and known to drive a Th2 immune response, has not yet been described during AE. Wild-type (WT) and IL-33-/- C57BL/6J mice were infected by peritoneal inoculation with E. multilocularis metacestodes and euthanized 4 months later, and their immune response were analyzed. Immunofluorescence staining and IL-33 enzyme-linked immunosorbent assay (ELISA) were also performed on liver samples from human patients with AE. Overall, metacestode lesions were smaller in IL-33-/- mice than in WT mice. IL-33 was detected in periparasitic tissues, but not in mouse or human serum. In infected mice, endogenous IL-33 modified peritoneal macrophage polarization and cytokine profiles. Th2 cytokine concentrations were positively correlated with parasite mass in WT mice, but not in IL-33-/- mice. In human AE patients, IL-33 concentrations were higher in parasitic tissues than in distant liver parenchyma. The main sources of IL-33 were CD31+ endothelial cells of the neovasculature, present within lymphoid periparasitic infiltrates together with FOXP3+ Tregs. In the murine model, periparasitic IL-33 correlated with accelerated parasite growth putatively through the polarization of M2-like macrophages and release of immunosuppressive cytokines IL-10 and transforming growth factor β1 (TGF-β1). We concluded that IL-33 is a key alarmin in AE that contributes to the tolerogenic effect of systemic Th2 cytokines. IMPORTANCE Infection with the metacestode stage of Echinococcus multilocularis, known as alveolar echinococcosis, is the most severe cestodosis worldwide. However, less than 1% of exposed individuals, in which the immune system is unable to control the parasite, develop the disease. The factors responsible for this interindividual variability are not fully understood. In this in vivo study comparing wild-type and IL-33-/- infected mice, together with data from human clinical samples, we determined that IL-33, an alarmin released following tissue injury and involved in the pathogenesis of cancer and asthma, accelerates the progression of the disease by modulating the periparasitic microenvironment. This suggests that targeting IL-33 could be of interest for the management of patients with AE, and that IL-33 polymorphisms could be responsible for increased susceptibility to AE.
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Affiliation(s)
- Brice Autier
- IRSET (UMR_S 1085), INSERM (Institut de recherche en santé, environnement et travail), EHESP, CHU Rennes, University of Rennes, Rennes, France
| | - Christelle Manuel
- IRSET (UMR_S 1085), INSERM (Institut de recherche en santé, environnement et travail), EHESP, University of Rennes, Rennes, France
| | - Britta Lundstroem-Stadelmann
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Jean-Philippe Girard
- Institut de Pharmacologie et de Biologie Structurale (IPBS), Université de Toulouse, Toulouse, France
| | - Bruno Gottstein
- Institute of Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Jean-Pierre Gangneux
- IRSET (UMR_S 1085), INSERM (Institut de recherche en santé, environnement et travail), EHESP, CHU Rennes, University of Rennes, Rennes, France
| | - Michel Samson
- IRSET (UMR_S 1085), INSERM (Institut de recherche en santé, environnement et travail), EHESP, University of Rennes, Rennes, France
| | - Florence Robert-Gangneux
- IRSET (UMR_S 1085), INSERM (Institut de recherche en santé, environnement et travail), EHESP, CHU Rennes, University of Rennes, Rennes, France
| | - Sarah Dion
- IRSET (UMR_S 1085), INSERM (Institut de recherche en santé, environnement et travail), EHESP, University of Rennes, Rennes, France
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Vlok M, Buckley HR, Domett K, Willis A, Tromp M, Trinh HH, Minh TT, Mai Huong NT, Nguyen LC, Matsumura H, Huu NT, Oxenham MF. Hydatid disease (Echinococcosis granulosis) diagnosis from skeletal osteolytic lesions in an early seventh-millennium BP forager community from preagricultural northern Vietnam. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:100-115. [PMID: 36787713 DOI: 10.1002/ajpa.24435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Con Co Ngua is a complex, sedentary forager site from northern Vietnam dating to the early seventh millennium BP. Prior research identified a calcified Echinococcus granulosis cyst, which causes hydatid disease. Osteolytic lesions consistent with hydatid disease were also present in this individual and others. Hydatid disease is observed in high frequencies in pastoralists, and its presence in a hunter-gatherer community raises questions regarding human-animal interaction prior to farming. The objective of this article is to identify and describe the epidemiology of hydatid disease in the human skeletal assemblage at Con Co Ngua. MATERIALS AND METHODS One hundred and fifty-five individuals were macroscopically assessed for lesions. Of these, eight individuals were radiographed. Hydatid disease was diagnosed using a new threshold criteria protocol derived from clinical literature, which prioritizes lesions specific to the parasite. RESULTS Twenty-two individuals (14.2%) presented with osteolytic lesions consistent with hydatid disease, affecting the distal humerus, proximal femur and forearm, and pelvis. Seven individuals radiographed (4.5%) had multilocular cystic lesions strongly diagnostic for hydatid disease. All probable cases had lesions of the distal humerus. The remaining lesions were macroscopically identical to those radiographed and were considered possible cases. DISCUSSION While hydatid disease has previously been found in pre-agricultural communities, the high prevalence at Con Co Ngua is non-incidental. We propose that the presence of wild canids and management of wild buffalo and deer increased the risk of disease transmission. These findings further reveal subsistence complexity among hunter-gatherers living millennia prior to the adoption of farming in Southeast Asia.
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Affiliation(s)
- Melandri Vlok
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Hallie R Buckley
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Kate Domett
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Anna Willis
- College of Arts, Society & Education, James Cook University, Townsville, Australia
| | - Monica Tromp
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,School of Social Sciences, University of Otago, Dunedin, New Zealand.,Department of Archaeology, Max Planck Institute for the Science of Human History, Jena, Germany
| | | | | | | | | | | | | | - Marc F Oxenham
- School of Archaeology and Anthropology, The Australian National University, Canberra, Australia.,Department of Archaeology, University of Aberdeen, Scotland, UK
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The spectrum of multimodality imaging findings in hepatic alveolar echinococcosis and the potential role of diffusion-weighted imaging in its characterisation. Pol J Radiol 2020; 85:e613-e623. [PMID: 33376563 PMCID: PMC7757515 DOI: 10.5114/pjr.2020.101015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To study the spectrum of imaging findings in hepatic alveolar echinococcosis (HAE) and to evaluate the potential role of diffusion-weighted imaging (DWI) in its characterisation. Material and methods Two radiologists with more than seven years of experience retrospectively studied ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) findings in 23 histopathologically proven cases of HAE with emphasis on the appearance and extent of disease. DWI characteristics of lesions were noted, and their apparent diffusion values (ADC) were calculated. Results Ultrasonography features of HAE included heterogeneous, hyperechoic hepatic mass with or without calcification (n = 20), or heterogeneous mass with solid-cystic appearance (n = 2). CT revealed heterogeneous density infiltrative hepatic mass with no contrast enhancement in 19 patients or thick-walled cystic mass (n = 4). Following Kodama classification one type 1, six type 2, two type 3, eight type 4, and two type 5 lesions were identified on T2-weighted MRI. No enhancement was seen on post-contrast T1-weighted images. Mean ADC values were 1.74 ± 0.48 × 10-3 mm2/s (range: 1.39 × 10-3 mm2/s to 2.3 × 10-3 mm2/s). Conclusions HAE by virtue of its infiltrative growth pattern with a tendency to involve biliary, vascular, and extra hepatic structures can be easily misdiagnosed as malignant hepatic neoplasm. Knowledge of varied imaging appearances of HAE is essential to suspect the condition and to make an appropriate diagnosis. Diffusion-weighted imaging is a useful adjunct with relatively high diffusivity (high ADC values) suggesting diagnosis of alveolar hydatid.
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Ünal E, Arslan S, Onur MR, Akpinar E. Parasitic diseases as a cause of acute abdominal pain: imaging findings. Insights Imaging 2020; 11:86. [PMID: 32691171 PMCID: PMC7371776 DOI: 10.1186/s13244-020-00892-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Acute abdominal pain can be seen in cases with parasitic diseases delivered to emergency departments. The diagnosis of the parasitic disease can be delayed because of the similar clinical signs encountered in other frequently seen causes of acute abdomen. Nevertheless, the features detected in imaging scans can be helpful in the diagnosis. The present study aims to raise awareness about abdominal parasitosis in emergency conditions and also to underline the association between imaging findings and the life cycle of parasites with illustrative cases.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Sevtap Arslan
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Erhan Akpinar
- Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Abstract
Hepatobiliary infections account for a small but clinically important proportion of emergency department presentations. They present a clinical challenge due to the broad range of imaging characteristics on presentation. Recognition of complications is imperative to drive appropriate patient care and resource utilization to avoid diagnostic pitfalls and avert adverse patient outcomes. A thorough understanding of anatomy infectious pathology of hepatobiliary system is essential in the emergency setting to confidently diagnose and guide medical intervention. Many presentations of hepatobiliary infection have characteristic imaging features on individual imaging modalities with others requiring the assimilation of findings of multiple imaging modalities along with incorporating the clinical context and multispecialist consultation. Familiarity with the strengths of individual imaging modalities in the radiologists' arsenal is imperative to guide the appropriate utilization of resources, particularly in the emergent time sensitive setting. Accurate identification and diagnosis of hepatobiliary infections is vital for appropriate patient care and management stratification.
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Affiliation(s)
- Daniel Hynes
- University of Massachusetts Medical School, Baystate Medical Center, Department of Radiology, Springfield, MA.
| | - Christina Duffin
- University of Massachusetts Medical School, Baystate Medical Center, Department of Radiology, Springfield, MA
| | - Tara Catanzano
- University of Massachusetts Medical School, Baystate Medical Center, Department of Radiology, Springfield, MA
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Liu H, Zhang C, Fan X, Duan Y, Xiao T, Du G, Fu Y, Liu H, Wen H. Robust phase-retrieval-based X-ray tomography for morphological assessment of early hepatic echinococcosis infection in rats. PLoS One 2017; 12:e0183396. [PMID: 28886025 PMCID: PMC5590738 DOI: 10.1371/journal.pone.0183396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/03/2017] [Indexed: 11/24/2022] Open
Abstract
Propagation-based phase-contrast computed micro-tomography (PPCT) dominates the non-destructive, three-dimensional inner-structure measurement in synchrotron-based biomedical research due to its simple experimental setup. To quantitatively visualize tiny density variations in soft tissues and organs closely related to early pathological morphology, an experimental study of synchrotron-based X-ray PPCT combined with generalized phase and attenuation duality (PAD) phase retrieval was implemented with the hepatic echinococcosis (HE) infection rat model at different stages. We quantitatively analyzed and evaluated the different pathological characterizations of hepatic echinococcosis during the development of this disease via our PAD-based PPCT and especially provided evidence that hepatic alveolar echinococcosis invades the liver tissue and spreads through blood flow systems with abundant blood supply in the early stage. Additionally, the infiltration of tiny vesicles in HE lesions can be clearly observed by our PAD-PPCT technique due to the striking contrast-to-noise ratio (CNR) and mass density resolution, which cannot be found by the medical imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound, in hospitals. The results demonstrated that our PAD-PPCT technique has a great potential for indicating the subtle structural information of pathological changes in soft biomedical specimens, especially helpful for the research of early micro-morphology of diseases.
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Affiliation(s)
- Huiqiang Liu
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
| | - Chuanshan Zhang
- State Key Laboratory Incubation Base of Xinjiang Major Diseases Research, FirstAffiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Xiaoxi Fan
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
| | - Yingni Duan
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
| | - Tiqiao Xiao
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, China
| | - Guohao Du
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, China
| | - Yanan Fu
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, China
| | - Haigang Liu
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, China
| | - Hao Wen
- State Key Laboratory Incubation Base of Xinjiang Major Diseases Research, FirstAffiliated Hospital, Xinjiang Medical University, Urumqi, China
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Bulakçı M, Kartal MG, Yılmaz S, Yılmaz E, Yılmaz R, Şahin D, Aşık M, Erol OB. Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update. Diagn Interv Radiol 2017; 22:247-56. [PMID: 27082120 DOI: 10.5152/dir.2015.15456] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alveolar echinococcosis is a parasitic disease limited to the northern hemisphere. The disease occurs primarily in the liver and shows a profile mimicking slow-growing malignant tumors. Echinococcus multilocularis infection is fatal if left untreated. It can cause several complications by infiltrating the vascular structures, biliary tracts, and the hilum of the liver. As it can invade the adjacent organs or can spread to distant organs, alveolar echinococcosis can easily be confused with malignancies. We provide a brief review of epidemiologic and pathophysiologic profile of alveolar echinococcosis and clinical features of the disease. This article focuses primarily on the imaging features of alveolar echinococcosis on ultrasonogra-phy, computed tomography, magnetic resonance imaging, diffusion-weighted imaging and positron emission tomography-computed tomography. We also reviewed the role of radiology in diagnosis, management, and follow-up of the disease.
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Affiliation(s)
- Mesut Bulakçı
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey.
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Pascal G, Azoulay D, Belghiti J, Laurent A. Hydatid disease of the liver. BLUMGART'S SURGERY OF THE LIVER, BILIARY TRACT AND PANCREAS, 2-VOLUME SET 2017:1102-1121.e3. [DOI: 10.1016/b978-0-323-34062-5.00074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Tousheed S, Dutt T, Muralimohan BV, Chatturambil B, Raj V, Raut P. A 36-year-old man with breathlessness and anasarca. Lung India 2017; 34:395-397. [PMID: 28671177 PMCID: PMC5504903 DOI: 10.4103/lungindia.lungindia_16_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Modern role of clinical ultrasound in liver abscess and echinococcosis. J Med Ultrason (2001) 2016; 44:239-245. [PMID: 27933440 DOI: 10.1007/s10396-016-0765-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
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13
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Liu H, Ji X, Sun L, Xiao T, Xie H, Fu Y, Zhao Y, Liu W, Zhang X, Lin R. Visualization and Pathological Characteristics of Hepatic Alveolar Echinococcosis with Synchrotron-based X-ray Phase Sensitive Micro-tomography. Sci Rep 2016; 6:38085. [PMID: 27897249 PMCID: PMC5126691 DOI: 10.1038/srep38085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022] Open
Abstract
Propagation-based phase-contrast computed tomography (PPCT) utilizes highly sensitive phase-contrast technology applied to X-ray micro-tomography, especially with the extensive use of synchrotron radiation (SR). Performing phase retrieval (PR) on the acquired angular projections can enhance image contrast and enable quantitative imaging. We employed the combination of SR-PPCT and PR for the histopathological evaluation of hepatic alveolar echinococcosis (HAE) disease and demonstrated the validity and superiority of PR-based SR-PPCT. A high-resolution angular projection data set of a human postoperative specimen of HAE disease was acquired, which was processed by graded ethanol concentration fixation (GECF). The reconstructed images from both approaches, with the projection data directly used and preprocessed by PR for tomographic reconstruction, were compared in terms of the tissue contrast-to-noise ratio and density spatial resolution. The PR-based SR-PPCT was selected for microscale measurement and the 3D visualization of HAE disease. Our experimental results demonstrated that the PR-based SR-PPCT technique is greatly suitable for the discrimination of pathological tissues and the characterization of HAE. In addition, this new technique is superior to conventional hospital CT and microscopy for the three-dimensional, non-destructive microscale measurement of HAE. This PR-based SR-PPCT technique has great potential for in situmicroscale histopathological analysis and diagnosis, especially for applications involving soft tissues and organs.
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Affiliation(s)
- Huiqiang Liu
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumchi 830011, China
| | - Xuewen Ji
- Hepatobiliary &Echinococcosis Surgery, FirstAffiliated Hospital, Xinjiang Medical University, Urumchi 830054, China
| | - Li Sun
- State Key Laboratory Incubation Base of Xinjiang Major Diseases Research, FirstAffiliated Hospital, Xinjiang Medical University, Urumchi 830054, China
| | - Tiqiao Xiao
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China
| | - Honglan Xie
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China
| | - Yanan Fu
- SSRF, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China
| | - Yuan Zhao
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University, Urumchi 830054, China
| | - Wenya Liu
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University, Urumchi 830054, China
| | - Xueliang Zhang
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumchi 830011, China
| | - Renyong Lin
- State Key Laboratory Incubation Base of Xinjiang Major Diseases Research, FirstAffiliated Hospital, Xinjiang Medical University, Urumchi 830054, China
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14
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Aydinli B, Ozogul B, Ozturk G, Kisaoglu A, Atamanalp SS, Kantarci M. Hepatic Alveolar Echinococcosis that Incidentally Diagnosed and Treated with R1 Resection. Eurasian J Med 2015; 44:127-8. [PMID: 25610224 DOI: 10.5152/eajm.2012.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 07/23/2012] [Indexed: 02/04/2023] Open
Abstract
In this report, we present an incidentally diagnosed and surgically treated patient with hepatic alveolar echinococcosis.
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Affiliation(s)
- Bulent Aydinli
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Bunyami Ozogul
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Gurkan Ozturk
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Abdullah Kisaoglu
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - S Selcuk Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Kantarci M, Pirimoglu B, Kizrak Y. Diagnostic imaging and interventional procedures in a growing problem: Hepatic alveolar echinococcosis. World J Surg Proced 2014; 4:13-20. [DOI: 10.5412/wjsp.v4.i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/19/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Alveolar echinococcosis (AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis (E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography (US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography (CT), magnetic resonance imaging (MRI), including magnetic resonance cholangiography (MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.
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Bracanovic D, Djuric M, Sopta J, Djonic D, Lujic N. Skeletal manifestations of hydatid disease in Serbia: demographic distribution, site involvement, radiological findings, and complications. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:453-9. [PMID: 24039289 PMCID: PMC3770877 DOI: 10.3347/kjp.2013.51.4.453] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/18/2013] [Accepted: 07/05/2013] [Indexed: 11/23/2022]
Abstract
Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9±18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.
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Affiliation(s)
- Djurdja Bracanovic
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade 11000, Serbia. ; Department of Radiology, School of Dental Medicine, University of Belgrade, Belgrade 11000, Serbia
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Geigy CA, Kühn K, Rütten M, Howard J, Grimm F, Rohrer Bley C. Unusual presentation of alveolar echinococcosis as prostatic and paraprostatic cysts in a dog. BMC Vet Res 2013; 9:159. [PMID: 23938212 PMCID: PMC3765175 DOI: 10.1186/1746-6148-9-159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/08/2013] [Indexed: 12/28/2022] Open
Abstract
Background Alveolar echinococcosis (AE) is caused by the larval stage (metacestode) of Echinococcus multilocularis. The domestic dog can act as a definitive host and harbor adult cestodes in its small intestine or become an aberrant intermediate host carrying larval stages that may cause severe lesions in the liver, lungs and other organs with clinical signs similar to AE in humans. Case presentation A case of canine AE, affecting the liver and prostate with development of multilocular hydatid paraprostatic cysts and possible lung involvement is described in an 8–year-old neutered male Labrador retriever dog. The dog presented with progressive weight loss, acute constipation, stranguria and a suspected soft tissue mass in the sublumbar region. Further evaluation included computed tomography of the thorax and abdomen, which revealed cystic changes in the prostate, a paraprostatic cyst, as well as lesions in the liver and lungs. Cytological examination of fine-needle aspirates of the liver, prostate and paraprostatic cyst revealed parasitic hyaline membranes typical of an Echinococcus infection and the presence of E. multilocularis-DNA was confirmed by PCR. The dog was treated with albendazole and debulking surgery was considered in case there was a good response to antiparasitic treatment. Constipation and stranguria resolved completely. Six months after the definitive diagnosis, the dog was euthanized due to treatment-resistant ascites and acute anorexia and lethargy. Conclusions To the authors’ knowledge, this is the first publication of an E. multilocularis infection in a dog causing prostatic and paraprostatic cysts. Although rare, E. multilocularis infection should be considered as an extended differential diagnosis in dogs presenting with prostatic and paraprostatic disease, especially in areas where E. multilocularis is endemic.
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Affiliation(s)
- Caroline A Geigy
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Chu ZG, Lv FJ, Zhu ZY, Ouyang Y. Extrahepatic primary adrenal alveolar echinococcosis: a review. Surg Infect (Larchmt) 2013; 14:418-21. [PMID: 23859690 DOI: 10.1089/sur.2012.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary echinococcosis, and especially primary alveolar echinococcosis (AE) is rare among adrenal lesions. METHODS We report a case of primary AE in a 28-year-old male with low backache and occasional upper limb pain lasting for six months, and review the pertinent but sparse literature on this disorder. RESULTS Evaluation of the patient revealed an abdominal mass as right adrenal AE. The adrenal gland is a rare extrahepatic site of occurrence of echinococcosis, and particularly of AE. Patients with adrenal echinococcosis usually have nonspecific clinical symptoms. Imaging examinations revealed clearly the features of AE and its surrounding pathology. Alveolar echinococcosis was seen as an inhomogeneous pseudotumor with irregular boundaries, an irregular central pseudocystic appearance, and infiltration into surrounding structures. On contrast-enhanced computed tomography, the periphery of the mass in AE may be enhanced and multicentric vesicles may be seen. Magnetic resonance imaging may show the multivesicular morphology of lesions. The definitive diagnosis of AE should be confirmed by pathologic or serologic examination. Radical surgical resection of the removable parasitic lesion, followed by anti-infective therapy with benzimidazoles, is the primary method for treating AE. CONCLUSION Although primary adrenal AE is rare, it should be included in the differential diagnosis of adrenal masses, especially in regions where AE is endemic.
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Affiliation(s)
- Zhi-gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Kantarci M, Bayraktutan U, Karabulut N, Aydinli B, Ogul H, Yuce I, Calik M, Eren S, Atamanalp SS, Oto A. Alveolar echinococcosis: spectrum of findings at cross-sectional imaging. Radiographics 2013; 32:2053-70. [PMID: 23150858 DOI: 10.1148/rg.327125708] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Alveolar echinococcosis is a rare parasitic disease caused by the fox tapeworm Echinococcus multilocularis, which is endemic in many parts of the world. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiologic imaging and in serologic analyses. Because echinococcal lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Echinococcal lesions may produce widely varied imaging appearances depending on the parasite's growth stage, the tissues or organs affected, and the presence of associated complications. Although the liver is the initial site of mass infestation by E multilocularis, the parasite may disseminate from there to other organs and tissues, such as the lung, heart, brain, bones, and ligaments. In severe infestations, the walls of the bile ducts and blood vessels may be invaded. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. Ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging with standard and diffusion-weighted sequences, and MR cholangiopancreatography all provide useful information and play complementary roles in detecting and characterizing echinococcal lesions. Cross-sectional imaging is crucial for differentiating echinococcosis from malignant processes: CT is most useful for depicting the peripheral calcifications surrounding established echinococcal cysts, and MR imaging is most helpful for identifying echinococcosis of the central nervous system.
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Affiliation(s)
- Mecit Kantarci
- Department of Radiology, Atatürk University, School of Medicine, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum 25090, Turkey.
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OIKAWA E, SHIMURA R, NISHIMURA M, FURUOKA H. First Case of Echinococcus multilocularis Infection in a Zoo-Housed Flying Squirrel ( Pteromys volans orii). J Vet Med Sci 2013; 75:659-61. [DOI: 10.1292/jvms.12-0455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eri OIKAWA
- Division of Pathobiological Science, Department of Basic Veterinary Medicine Obihiro University of Agriculture and Veterinary Medicine, Obihiro 080–8555, Japan
| | | | - Maki NISHIMURA
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro 080–8555, Japan
| | - Hidefumi FURUOKA
- Division of Pathobiological Science, Department of Basic Veterinary Medicine Obihiro University of Agriculture and Veterinary Medicine, Obihiro 080–8555, Japan
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Zeng H, Wang J, Xie W, Liu W, Wen H. Assessment of early hepatic echinococcus multilocularis infection in rats with real-time contrast-enhanced ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1982-1988. [PMID: 22929653 DOI: 10.1016/j.ultrasmedbio.2012.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/08/2012] [Accepted: 07/13/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to demonstrate characteristic imaging and accurate evaluation of blood perfusion in early stage of hepatic alveolar echinococcosis (HAE) by contrast-enhanced ultrasonography (CEUS). The early stage of experimentally induced secondary HAE in 45 rats was studied. Thirty-six HAE lesions in 33 rats, confirmed by pathologic examination, were examined by ultrasound (US), color Doppler flow imaging (CDFI) and then CEUS. Thirty-three lesions were found in 30 rats by US, and 30 lesions were detected in 27 rats by CEUS. The sensitivity of US and CEUS was 92% (95% CI 76%-98%) and 82% (95% CI 65%-93%), respectively. US imaging characteristics were categorized into four types: hyperechoic spot (type 1, 45.5%, 15/33), granular hyperechoic spots (type 2, 12.1%, 4/33), hyperechoic lesion (type 3, 30.3%, 10/33) and mixed pattern (type 4, 12.1%, 4/33). CDFI failed to detect blood flow signals in any lesions. CEUS results for 30 lesions showed ring enhancement in the peripheral area during the arterial phase and no filling effect in either the portal or the delayed phase (46.7%, 14/30); ring enhancement combined with central septa enhancement during the arterial phase and portal venous phase (46.7, 14/30), and no enhancement (6.6%, 2/30). The enhanced area, confirmed by pathologic examination, was an inflammatory reaction belt surrounding the lesion. The results of this study suggest that US, with high sensitivity, can be used as a screening method for early HAE lesions in the animal model, while CEUS can be used for displaying the peripheral blood perfusion and vesicle structure.
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Affiliation(s)
- Hongchun Zeng
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
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22
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Answer to September 2012 Photo Quiz. J Clin Microbiol 2012. [DOI: 10.1128/jcm.00704-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tao S, Qin Z, Hao W, Yongquan L, Lanhui Y, Lei Y. Usefulness of gray-scale contrast-enhanced ultrasonography (SonoVue®) in diagnosing hepatic alveolar echinococcosis. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1024-1028. [PMID: 21640477 DOI: 10.1016/j.ultrasmedbio.2011.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 04/12/2011] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
Hepatic alveolar echinococcosis (HAE) is a parasitic infection with an infiltrative growth pattern that has the appearance of a hepatic malignant tumor. Ultrasound (US) has been used for screening of HAE in epidemic areas. However, it has been very difficult to evaluate the clear boundary and microvessel perfusion of the lesions. The aim of this study was to demonstrate the characteristic imaging and clinical significance of HAE lesions by contrast-enhanced ultrasonography (CEUS). Seventeen patients with 19 HAE lesions were examined in sequence with US, color Doppler flow imaging (CDFI) and then CEUS before any treatment. All the data were compared before surgery. Examined by fundamental US, 47.4% of HAE lesions showed irregular hyperechoic substantive areas and 52.6% appeared as having a mixed echotype with irregular anechoic areas in the central portion of the lesions. The CDFI method indicated no blood flow signals inside any of the 19 lesions. By CEUS, all 19 lesions displayed circular rim enhancement in the peripheral segments and absent enhancement within the central areas of the lesions (a "black hole" effect). As a result, the lesions' margins were clear, irregular and distinct. In general, the sizes of all the HAE lesions observed by CEUS were larger than those obtained by fundamental US. Therefore, CEUS is a simple imaging method and can be a helpful tool for more accurate sizing of HAE lesions and their surrounding invasion range and the proper cut-off margin when radical hepatectomy is needed.
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Affiliation(s)
- Song Tao
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, PR China
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Dulger AC, Kemik O, Selvi F, Begenik H, Emre H, Erdur FM. Hepatic Encephalopathy in Connection With Budd-Chiari Syndrome due to Infection With Echinococcus Multilocularis: A Case Report. Gastroenterology Res 2011; 4:127-130. [PMID: 27942328 PMCID: PMC5139819 DOI: 10.4021/gr306e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2011] [Indexed: 11/30/2022] Open
Abstract
Budd-Chiari syndrome (BCS) is a hepatic venous outflow block generally resulting from disorders affecting hepatic venous system. Elevated hepatic venous pressure results in portal hypertension. BCS may also cause hepatic encephalopathy. Echinococcus multilocularis is a tapeworm parasite and the natural course of the disease may affect liver parenchyma as well as hepatic venous tree. It is the most terrible parasitic disease of the liver and is easily confused with hepatic malignancies. Albendazole therapy may suppress disease progression. Alveolar echinococcosis of the liver rarely causes Budd-Chiari syndrome-related hepatic encephalopathy (HE). We report a rare case of alveolar echinococcosis-related BCS with HE, who was successfully managed by rifaximin and albendazole.
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Affiliation(s)
- Ahmet Cumhur Dulger
- Department of Gastroenterology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Ozgur Kemik
- Department of General Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Fatih Selvi
- Department of Emergency Medicine, Medical Faculty, Yuzuncu Yil University,Van, Turkey
| | - Huseyin Begenik
- Department of Internal Medicine, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Habib Emre
- Department of Internal Medicine, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Fatih Mehmet Erdur
- Department of Internal Medicine, Medical Faculty, Yuzuncu Yil University, Van, Turkey
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Calcifications hépatiques de l’adulte : les stars de l’ASP trop souvent négligées à l’ère du scanner. ACTA ACUST UNITED AC 2010; 91:759-68. [DOI: 10.1016/s0221-0363(10)70113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Alveolar hydatid disease of the adrenal gland: computed tomography and magnetic resonance imaging findings. Jpn J Radiol 2009; 27:225-8. [PMID: 19554417 DOI: 10.1007/s11604-009-0326-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
Abstract
Echinococcosis is a parasitic infection of humans caused by the larval stage of the tapeworm Echinococcus. Primary alveolar echinococcosis of the adrenal gland is rare. We report a case of alveolar hydatid disease of the adrenal gland that presented as a multiloculated cystic mass without calcification. The lesion was purely cystic in nature, suggesting that it was at an early stage of development.
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Meimarakis G, Grigolia G, Loehe F, Jauch KW, Schauer RJ. Surgical management of splenic echinococcal disease. Eur J Med Res 2009; 14:165-70. [PMID: 19380289 PMCID: PMC3401006 DOI: 10.1186/2047-783x-14-4-165] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Infection of the spleen with echinococcus is a rare clinical entity. Because the diagnosis of a splenic infestation with echinococcus is sometimes delayed, large hydatid cysts or pseudotumors may develop, demanding a differential surgical approach to cure the disease. Methods In a retrospective study 10 patients out of 250 with abdominal echinococcosis (4%) were identified to have splenic infestation, either limited to the spleen (n = 4) or with synchronous involvement of the liver (n = 4), major omentum (n = 1), or the liver and lung (n = 1). Only one patient had alveolar echinococcosis whereas the others showed hydatid cysts of the spleen. Surgical therapy included splenectomy in 7 patients or partial cyst excision combined with omentoplasty in 3 patients. In case of liver involvement, pericystectomy was carried out simultaneously. Results There was no mortality. Postoperative complications were observed in 4 patients. Hospital stay and morbidity were not influenced when splenic procedures were combined with pericystectomies of the liver. Mean follow- up was 8.8 years and all of the patients are free of recurrence at this time. Conclusions Splenectomy should be the preferred treatment of hydatid cysts but partial cystectomy is suitable when the cysts are located at the margins of the spleen. Due to low morbidity rates, simultaneous treatment of splenic and liver hydatid cysts is recom mended.
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Affiliation(s)
- G Meimarakis
- Surgical Department, Klinikum Grosshadern, Ludwig-Maximillians University of Munich, Germany
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Czermak BV, Akhan O, Hiemetzberger R, Zelger B, Vogel W, Jaschke W, Rieger M, Kim SY, Lim JH. Echinococcosis of the liver. ACTA ACUST UNITED AC 2008; 33:133-43. [PMID: 17912581 DOI: 10.1007/s00261-007-9331-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Echinococcosis, also known as hydatid disease, is an infection of larval stage animal tapeworm, Echinococcus. The larvae reside in the liver and lungs, producing multiloculated fluid-filled cysts. Imaging findings of Echinococcosis caused by E. granulosus are single, unilocular cyst or multiseptated cysts, showing "wheel-like", "rosette-like" or "honeycomb-like" appearances. There may be "snow-flakes" sign, reflecting free floating protoscoleces (hydatid-sand) within the cyst cavity. Degenerating cysts show wavy or serpentine bands or floating membranes representing detached or ruptured membranes. Degenerated cysts show heterogeneous, solid-looking pseudotumor that may show "ball of wool sign". Dead cysts show calcified cyst wall. Echinococcosis caused by E. multilocularis produces multilocular alveolar cysts with exogeneous proliferation, progressively invading the liver parenchyma and other tissues of the body. Imaging findings are ill-defined infiltrating lesions of the liver parenchyma, consisting of multiple small clustered cystic and solid components. On sonography, lesions are heterogeneous with indistinct margins, showing "hailstorm appearance" or "vesicular or alveolar appearance". CT and MR imaging displays multiple, irregular, ill-defined lesions. Multiple small round cysts with solid components are frequent. Large lesions show "geographical map" appearance. Calcifications are very frequent, appearing as peripheral calcification or punctuate scattered calcific foci. Invasion into the bile ducts, portal vein or hepatic vein may occur. Direct spread of infected tissue may result in cysts in the peritoneal cavity, kidneys, adrenal gland or bones.
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Affiliation(s)
- Benedikt V Czermak
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Rubini-Campagna A, Kermarrec E, Laurent V, Régent D. Échinococcose alvéolaire hépatique et extra-hépatique : revue iconographique en scanner et en IRM. ACTA ACUST UNITED AC 2008; 89:765-74. [DOI: 10.1016/s0221-0363(08)73782-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Osseous hydatid disease. Trans R Soc Trop Med Hyg 2007; 102:233-8. [PMID: 17996916 DOI: 10.1016/j.trstmh.2007.09.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/18/2007] [Accepted: 09/19/2007] [Indexed: 12/31/2022] Open
Abstract
Hydatid disease is still endemic in several regions worldwide and is caused in most cases by the larval form of two species of the tapeworm Echinococcus: E. granulosus and E. multilocularis. Bone involvement is rare (0.2-4%), affecting the spine in almost half of the cases. The disease is usually silent until a complication (e.g. paraplegia or pathologic fracture) occurs. Many cases are diagnosed intraoperatively. Pre-operative diagnosis is based on radiological findings and serological assays, which lack high sensitivity and specificity. A high index of suspicion is necessary for the diagnosis, especially in patients that live in or travel to sheep-raising areas where hydatid disease is endemic. The treatment of choice is surgical, following the principles of a locally malignant lesion. Chemotherapy (albendazole alone or in combination with praziquantel) is used as an adjuvant treatment or when surgery is not possible. The prognosis is often poor, especially in the spine: most patients do not recover neurologically, the mortality and complication rate is high and many cases recur, as it is often impossible to radically excise the pathologic tissue.
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Kotil K, Tatar Z, Bilge T. Spinal hydatidosis accompanied by a secondary infection. Case report. J Neurosurg Spine 2007; 6:585-90. [PMID: 17561751 DOI: 10.3171/spi.2007.6.6.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal hydatid disease is rarely encountered in nonendemic regions. It is a progressive disease that is associated with risks of serious morbidity. The authors report a case of an isolated primary hydatid cyst of the spine in a 34-year-old woman who presented with back pain, which had lasted for 3 months, as well as lower-extremity pain and fatigue, which had persisted for 2 months. A neurological examination yielded findings indicative of upper motor neuron involvement with complete sensory loss below the level of T-11. Magnetic resonance imaging of the spine showed multiple extradural cystic lesions with an abscess formation at T-11 and involvement of the paraspinal muscles. The patient underwent spinal decompression in which stabilization and total excision of the multiple epidural and psoas abscesses and paraspinal multiloculated cysts were performed. The diagnosis of hydatid disease associated with another infection was confirmed by histopathological evaluation. Albendazole was administered during the postoperative period. Previous reports of secondary infections accompanying this disease in extraspinal locations have been published. However, to the best of the authors' knowledge, there have been no publications about a secondary infection associated with hydatidosis in the spinal cord. One should bear in mind that spinal hydatidosis may be accompanied by other infections in endemic regions. Antihelminthic treatment should be administered for a long period following early decompressive surgery and adequate stabilization.
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Affiliation(s)
- Kadir Kotil
- Departments of Neurosurgery, Haseki Educational and Research Hospital, Istanbul, Turkey.
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Asanuma T, Kawahara T, Inanami O, Nakao M, Nakaya K, Ito A, Takiguchi M, Hashimoto A, Kuwabara M. Magnetic Resonance Imaging of Alveolar Echinococcosis Experimentally Induced in the Rat Lung. J Vet Med Sci 2006; 68:15-20. [PMID: 16462111 DOI: 10.1292/jvms.68.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulmonary alveolar echinococcosis (AE) caused by the metacestode of Echinococcus multilocularis is a lethal zoonosis and is a lesion secondarily induced by hematogenous dissemination from hepatic AE lesions. In the present study, a hematogenous pulmonary AE model was experimentally induced in rats by the injection of echinococcal larval tissue homogenate to the tail vein, and then the pathological and diagnostic aspects of pulmonary AE were examined by magnetic resonance imaging (MRI). Histological primary, mature and degenerated AE lesions were observed 5, 18 and 50 weeks after injection, respectively. These lesions were discriminated as signal-void, hypointense and hyperintense regions in T1-weighted MRI (T1WI), respectively. The change in signal intensity in T1WI might reflect the content of proteinaceous fluid as a result of AE cyst degeneration. Western blot analysis of sera with antibodies of two epitopes (Em18 and Em16) of E. multilocularis provided evidence for AE infection in the early stage. T1WI in combination with Western blot analysis could possibility become definitive and early signs of hematogenous pulmonary AE infection.
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Affiliation(s)
- Taketoshi Asanuma
- Laboratory of Radiation Biology, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
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Abstract
Ultrasound evaluation of patients with hepatic masses should extend beyond basic lesion detection to characterization and clinical management. A systematic approach for hepatic lesion evaluation using ultrasound makes it possible to triage patients and, in many cases, leads to definitive diagnosis that may eliminate the need for additional imaging.
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Affiliation(s)
- Duan Li
- Body Imaging, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Kratzer W, Reuter S, Hirschbuehl K, Ehrhardt AR, Mason RA, Haenle MM, Kern P, Gabelmann A. Comparison of contrast-enhanced power Doppler ultrasound (Levovist) and computed tomography in alveolar echinococcosis. ACTA ACUST UNITED AC 2005; 30:286-90. [PMID: 15965776 DOI: 10.1007/s00261-004-0263-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To date, no study has compared unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound with three-phase helical computed tomography (CT) for the analysis of the vascularization of hepatic lesions in patients who have alveolar echinococcosis. METHODS Fifteen patients (11 female and four male; average age, 45.8 years) with confirmed Echinococcus multilocularis infection underwent unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound (2- to 5-MHz transducer head) and three-phase helical CT. The largest identified lesion in each patient was studied. RESULTS CT visualized vascularization peripheral or central to the largest echinococcal lesions in 11 of 15 patients. Vascularization in the area of the echinococcal lesions was not visualized by unenhanced or contrast-enhanced power Doppler ultrasound in any of the 15 patients studied. CONCLUSION Three-phase helical CT visualizes the vascularization associated with Echinococcus multilocularis lesions in the liver. Neither unenhanced nor contrast-enhanced ultrasound in power mode is suitable for this application.
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Affiliation(s)
- W Kratzer
- Abteilung Innere Medizin I, Universität Ulm, Robert-Koch-Strasse 8, D-89081 Ulm, Germany.
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Abstract
Recent technologic advances have significantly enhanced the role of imaging in the detection, characterization, and management of infectious diseases involving the liver. In addition, imaging-guided percutaneous drainage has greatly improved the clinical treatment of patients with focal liver abscess. Infectious liver diseases can be accurately evaluated with ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. Characteristic changes in US echogenicity, CT attenuation, or MR imaging signal intensity and typical enhancement patterns can contribute to the diagnosis of specific infectious diseases, including abscesses, parasitic diseases, fungal diseases, granulomatous diseases, viral hepatitis, and other less common infections. CT is particularly helpful in revealing the presence of calcifications and gas and in detailing the enhancement pattern. The multiplanar capability of MR imaging and its sensitivity to small differences in tissue composition increase its specificity for certain hepatic infections, including hydatid cyst and candidiasis. Radiologic findings may be sufficient to obviate aspiration or histologic examination, although in most instances they are less specific. Nevertheless, imaging findings taken together with appropriate clinical information may provide the most likely diagnosis, even if biopsy is sometimes required for confirmation.
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MESH Headings
- Angiomatosis, Bacillary/diagnostic imaging
- Angiomatosis, Bacillary/pathology
- Animals
- Candidiasis/diagnostic imaging
- Candidiasis/pathology
- Cat-Scratch Disease/diagnostic imaging
- Cat-Scratch Disease/pathology
- Echinococcosis, Hepatic/diagnostic imaging
- Echinococcosis, Hepatic/pathology
- Granuloma/diagnostic imaging
- Granuloma/pathology
- HIV Infections/diagnostic imaging
- HIV Infections/pathology
- Hepatitis/diagnostic imaging
- Hepatitis/pathology
- Hepatitis, Viral, Human/diagnostic imaging
- Hepatitis, Viral, Human/pathology
- Humans
- Liver Abscess/diagnostic imaging
- Liver Abscess/pathology
- Liver Abscess, Amebic/diagnostic imaging
- Liver Abscess, Amebic/pathology
- Magnetic Resonance Imaging
- Schistosomiasis/diagnostic imaging
- Schistosomiasis/pathology
- Tomography, X-Ray Computed
- Tuberculoma/diagnostic imaging
- Tuberculoma/pathology
- Tuberculosis, Hepatic/diagnostic imaging
- Tuberculosis, Hepatic/pathology
- Ultrasonography
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Affiliation(s)
- Koenraad J Mortelé
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Scharf G, Deplazes P, Kaser-Hotz B, Borer L, Hasler A, Haller M, Flückiger M. Radiographic, ultrasonographic, and computed tomographic appearance of alveolar echinococcosis in dogs. Vet Radiol Ultrasound 2004; 45:411-8. [PMID: 15487566 DOI: 10.1111/j.1740-8261.2004.04074.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Alveolar echinococcosis is a rare metacestodal infection of humans and domestic animals with Echinococcus multilocularis and predominantly affects the liver. In humans, diagnosis is based on serology, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), techniques that have not yet been validated for the diagnosis of alveolar echinococcosis in dogs. Therefore, the purpose of this retrospective study was to describe the radiographic, ultrasonographic, and CT appearance of canine alveolar echinococcosis. Eleven dogs with confirmed alveolar echinococcosis (PCR or histology from biopsy material of metacestode tissue) diagnosed between 1995 and 2003 were included in the study. The age of the dogs at initial presentation ranged from 7 months to 10.5 years. Abdominal radiographs were made in nine animals, abdominal ultrasonography was performed in 10 dogs, and two CT studies in one dog, respectively. The history, clinical presentation, and laboratory findings for the 11 dogs were unspecific, the most frequent clinical finding being nonpainful progressive abdominal distention. All radiographed dogs had large liver masses; they contained small mineralizations in five. The most frequent ultrasonographic finding was multiple large cavitary masses with or without wall mineralizations. Seven animals received surgical and subsequent medical therapy with albendazole (10mg/kg) and all went into clinical remission. This study reviewed for the first time imaging findings associated with alveolar echinococcosis. The disease has to be included in the list of differential diagnoses in dogs with large, cavitary liver masses, particularly when mineralization is noted.
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Affiliation(s)
- Gernot Scharf
- Diagnostic Imaging and Radio-Oncology, University of Zurich, Winterthurerstrasse 260, 8057 Zu- rich, Switzerland.
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Korkmaz M, Inceboz T, Celebi F, Babaoglu A, Uner A. Use of two sensitive and specific immunoblot markers, em70 and em90, for diagnosis of alveolar echinococcosis. J Clin Microbiol 2004; 42:3350-2. [PMID: 15243114 PMCID: PMC446319 DOI: 10.1128/jcm.42.7.3350-3352.2004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antibodies against Echinococcus multilocularis metacestodes were screened by immunoblotting sera from patients with alveolar echinococcosis (n = 39), cystic echinococcosis (n = 109), or other parasitic infections (n = 66) and healthy individuals (n = 32). Two antigens, approximately 70 and 90 kDa, are found to be valuable for confirmatory diagnosis, with a sensitivity and specificity of 100 and 99.51%, respectively.
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Affiliation(s)
- Metin Korkmaz
- Department of Parasitology, School of Medicine, Ege University, Izmir 35100, Turkey.
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Etlik Ö, Ünal Ö, Uygan İ, Bay A, Temizöz O, Sakarya ME. COINCIDENCE OF ECHINOCOCCUS ALVEOLARIS AND GRANULOSUS INFECTIONS IN THE SAME LIVER. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2004. [DOI: 10.29333/ejgm/82216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kodama Y, Fujita N, Shimizu T, Endo H, Nambu T, Sato N, Todo S, Miyasaka K. Alveolar echinococcosis: MR findings in the liver. Radiology 2003; 228:172-7. [PMID: 12750459 DOI: 10.1148/radiol.2281020323] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To clarify the magnetic resonance (MR) imaging findings of alveolar echinococcosis in the liver. MATERIALS AND METHODS Thirty-five patients with 50 lesions histologically proven to be alveolar echinococcosis were evaluated with MR imaging. Lesions were assessed with regard to the distribution pattern of solid and cystic components and pattern of contrast material enhancement. RESULTS Cystic components exhibited two patterns at T2-weighted MR imaging: small round cysts and large and/or irregular cysts. Forty-eight lesions (96%) contained small round cysts. Twenty-six lesions (52%) had large and/or irregular cysts. Forty-five lesions (90%) were associated with a solid component. MR imaging characteristics were categorized into five types: multiple small round cysts without a solid component (two lesions [4%], type 1), multiple small round cysts with a solid component (20 lesions [40%], type 2), a solid component surrounding large and/or irregular cysts with multiple small rounds cysts (23 lesions [46%], type 3), a solid component without cysts (two lesions [4%], type 4), and a large cyst without a solid component (three lesions [6%], type 5). In most cases (97%), contrast enhancement was weak. CONCLUSION The MR findings of alveolar echinococcosis in the liver are multiple small round cysts with a weakly enhanced solid component. The cystic component can be a large and/or irregular lesion, and such lesions are depicted clearly at T2-weighted MR imaging.
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Affiliation(s)
- Yoshihisa Kodama
- Department of Radiology and First Department of Surgery, Hokkaido University School of Medicine, N15, W7, Kitaku, Sapporo, 060-8638, Japan.
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Morris BS, Madiwale CV, Garg A, Chavhan GB. Hydatid disease of bone: a mimic of other skeletal pathologies. AUSTRALASIAN RADIOLOGY 2002; 46:431-4. [PMID: 12452919 DOI: 10.1046/j.1440-1673.2002.t01-1-01099.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Skeletal hydatidosis results from the deposition of the larval form of the Echinococcus, a genus of tapeworm. The incidence of bone disease is extremely low as most larvae are trapped by the liver and lung upon release of the embryo into the portal blood stream. The interpretation of imaging studies can prove very confusing because bone changes evolve with time, and the non-specificity of these findings often leads to a mistaken diagnosis. We present the case of a 35-year-old woman with long-standing pain in the left hip joint in which the findings on CT were thought of as being either tuberculous or neoplastic in nature. The result of a CT-guided biopsy and another done following surgery concurred on an unexpected diagnosis of a hydatid cyst. This case illustrates that in the absence of a high index of suspicion for echinococcal infection, the semblance of imaging findings of hydatid disease in bone to those of other skeletal pathologies can lead to misinterpretation.
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Affiliation(s)
- Burzin S Morris
- Department of Radiology, Seth GS Medical College, KEM Hospital, Mumbai, India.
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