Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

A rare case report: Primary isolated hydatid cyst of the spleen- diagnosis and management

INTRODUCTION AND IMPORTANCE

Hydatid disease is widespread in agricultural regions and globally. Tunisia is notably affected in the Mediterranean. Although liver involvement is common, splenic hydatidosis is rare, with incidence worldwide ranging from 0.5 % to 4 %. Surgery, particularly total or partial splenectomy, remains the primary treatment. We present a unique case of isolated splenic hydatid cyst successfully managed by total splenectomy.

CASE REPORT

A 40-year-old Tunisian farmer presented with persistent pain in the left hypochondrium for 4 months, accompanied by a sensation of heaviness. Physical examination revealed splenomegaly, and laboratory tests showed a positive Indirect Hemagglutination test for Echinococcus sp. (titer >160). Thoracoabdominal CT scan revealed a 10 cm splenic hydatid cyst. Surgery involved total splenectomy via an extended left subcostal approach. Postoperative recovery was uneventful, with successful albendazole therapy and vaccination following splenectomy. During biannual follow-up, the patient remained asymptomatic and did not present with any other hydatid localization.

CLINICAL DISCUSSION

Splenic hydatid cyst is rare. Diagnostic and therapeutic advancements are crucial for its management. Therapeutic options include total splenectomy, spleen preservation, and percutaneous interventions. However, these approaches carry unique risks and benefits. Close monitoring and individualized management are essential to ensure optimal outcomes.

CONCLUSION

Diagnosis of splenic hydatid cysts is challenging due to their often asymptomatic nature and lack of specific signs. With no standardized management protocols available, personalized treatment strategies are essential. Further research is crucial to improve treatment approaches and outcomes for this rare yet clinically important condition.

Percutaneous treatment of liver hydatid cysts: to PAIR or not to PAIR

PURPOSE OF REVIEW

The aim is to review recent literature for percutaneous treatment of liver hydatid cysts (cystic echinococcosis: CE) via different techniques such as PAIR (puncture, aspiration, injection, and reaspiration), standard catheterization, and modified catheterization technique (MoCaT).

RECENT FINDINGS

PAIR is an established technique and considered to be safe and effective for CE1 and CE3a as it is associated with lower morbidity, mortality, recurrence, and shorter hospital stay as compared with surgery. Standard catheterization is also dedicated for the treatment of CE1 and CE3a. PAIR should be preferred for treatment of liver CE1 and CE3a cysts, since PAIR is associated with lower major complication rates and shorter hospital stay. However, standard catheterization technique is indicated when cysto-biliary fistula develops or any technical difficulty arises during the PAIR. In these cases it is needed to switch PAIR to standard catheterization to complete the procedure.

SUMMARY

For CE1 and CE3a cysts, PAIR and standard catheterization are the choice for percutaneous treatments, while MoCaT is a treatment option for CE2 and CE3b cysts.

A massive primary hydatid splenic cyst was successfully managed through open total splenectomy: a case report and review article

Background

Cystic echinococcosis (CE) is a parasitic infection that is caused by the tapeworm Echinococcus granulosus. CE is very common, especially in the rural areas of developing countries. The most commonly affected organs by hydatid cysts are the liver and the lungs. However, the primary splenic hydatid cyst (PSHC) is a very rare manifestation of CE with an incidence of 0.5-8%.

Case presentation

A 17-year-old female patient presented with abdominal pain which gradually increased over months, along with anorexia and vomiting. Computerized tomography showed a massive splenic cystic mass. An open total splenectomy was performed. By follow-up, the platelet count and a postoperative chest X-ray were normal. The patient was prescribed Albendazole and analgesics. The pathological study confirmed the diagnosis of PSHC.

Conclusion

Despite the occurrence of PSHC being very rare, it is very important to take it into consideration, especially in endemic areas.

Case Report: Imaging-Guided Percutaneous Catheterization and Microwave Ablation of a Bone Hydatid Cyst with Soft-Tissue Component

Cystic echinococcosis (CE) of the bone is a rare disease compared with CE of the viscera, and the most involved bony structures are the spine and the pelvis. Both the diagnosis and the treatment of bone CE are challenging for several reasons. The combination of surgery and antimicrobial therapy is the most common approach, the results are far from adequate. Luckily, percutaneous treatment has appeared on the horizon for bone lesions as a more practical option with fewer drawbacks in light of current reports. This article deals with the successful result of ablation-assisted percutaneous treatment of a bone CE lesion and a soft tissue CE lesion treated by modified catheterization technique in a male patient with left hip pain that was unresponsive to previous surgery for CE.

Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?

The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients’ treatment and outcome. In this review, we aimed to increase imaging specialists’ awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.

Percutaneous Treatment of Bone Hydatid Cyst

Cystic echinococcosis (CE) may be encountered in almost every site of the body, but bone involvement is relatively rare. The vertebral column and pelvis are the most affected areas. The combined medical and surgical approach is the main treatment option in current literature. Although percutaneous treatment of CE cysts located in the liver, spleen, kidney, and soft tissues has become a serious alternative to surgery, there is no bone CE cyst treated percutaneously in the literature. This case report aims to point out that percutaneous treatment can be an effective treatment choice and alternative to surgery.

Renal Cystic Echinococcosis: Long-Term Outcomes of Percutaneous Treatment

PURPOSE

To evaluate the long-term outcomes of percutaneous treatment of renal cystic echinococcosis (CE) stratified by cyst stages according to the World Health Organization (WHO) classification.

MATERIALS AND METHODS

Between January 1997 and February 2019, 34 patients with renal CE (18 women; mean age, 38 years) were treated with 3 different percutaneous techniques. According to the World Health Organization classification, the cysts were classified as CE1, CE2, CE3a, and CE3b. Puncture, aspiration, injection, reaspiration (PAIR) or standard catheterization was used for the dimension-based treatment of CE1 and CE3a cysts. Modified catheterization (MoCaT) was used to treat all CE2 and CE3b cysts. Technical and clinical success, complications, and reduction in cyst cavities were evaluated.

RESULTS

The technical success rate was 100%. PAIR, standard catheterization, and MoCaT were used to treat 12, 9, and 13 cysts, respectively. The only severe adverse event was a bacterial superinfection that occured in the cyst cavity of a patient (3%) treated with MoCaT. Four patients (12%) experienced mild/moderate periprocedural allergic adverse events and were managed conservatively. The mean length of hospital stay was 1, 5, and 7 days for patients treated with PAIR, standard catheterization, and MoCaT, respectively. The clinical success rate was 97%. In 1 of 34 cysts (3%), recurrence was detected and the cyst was successfully re-treated. During the 10.5-year follow-up period, 95% volume reduction was achieved. The median final cyst volume was 10 mL.

CONCLUSIONS

Renal CE can be successfully treated with minimum adverse events and recurrence rates using appropriate percutaneous techniques selected according to their stages as classified according to WHO.

Percutaneous treatment with the Örmeci technique for hydatid disease located in the spleen: Single center experience for twenty six years

BACKGROUND/AIMS

Hydatid disease remains an important global socioeconomic health problem, particularly in the endemic areas. Although half of the patients show no symptoms, hydatid cysts should be treated because of their fatal complications. The aim of this study is to present the long-term results of percutaneous treatment of hydatid disease using the Örmeci technique.

MATERIALS AND METHODS

Forty-nine patients with 54 cystic lesions were diagnosed with hydatid disease. Twenty-seven of the 54 hydatid cysts located in the spleen were punctured with a 22-gauge Chiba needle through the parenchyma of the spleen under sonographic guidance as a one-step procedure. For every 1 cm of the long diameter of the cyst lesion, 3 cc of fluid from the cysts was aspirated. For each centimeter of the long diameter, 2 cc of pure alcohol (96%) and 1 cc of polidocanol (1%) were injected into the cysts. Five out of 27 patients did not participate in the follow-up.

RESULTS

The 22 patients who were treated using the percutaneous Örmeci technique were followed up for a mean±SD (median) of 50.32±65.30 (26.00) months (minimum 4 and maximum 298 months). All patients except one were successfully treated. No deaths or major complications were noted. Seven patients experienced minor complications.

CONCLUSION

Percutaneous treatment with the Örmeci technique is a safe, effective, cheap, and reliable method that does not interfere with splenic functions, and this outpatient procedure should be the method of choice for a surgery alternative.

Percutaneous Treatment of Non-parasitic Splenic Cysts: Long-Term Results for Single- Versus Multiple-Session Treatment

PURPOSE

The aim of this study was to investigate the efficacy and safety of percutaneous sclerotherapy for non-parasitic splenic cysts (NPSCs). The secondary aims were to introduce puncture-aspiration-injection-reaspiration (PAIR) technique in the treatment of NPSCs and to compare multiple- and single-session techniques.

MATERIALS AND METHODS

This retrospective study included 24 (17 females, 7 males) patients, treated between the years 1997 and 2015. Three techniques were used. Group A (n = 8), Group B (n = 6) and Group C (n = 10) were treated by PAIR, single-session catheterization and multiple-session catheterization, respectively. Since both PAIR and single-session catheterization techniques are carried out in a single session, Group A and Group B were evaluated in one group (Group A + B). Group A + B was compared with Group C in terms of patient demographics, the initial volume of the cysts, follow-up periods, complication and hospitalization rates and follow-up results. Recurrence and reduction rates were evaluated for two groups.

RESULTS

Technical success rate was 100%. The mean follow-up period was 68.9 months. Recurrence detected in 7 (29.1%) patients. Final reduction rate was between 40.7 and 100% (median 96.4%) with a significant difference in cyst volume (p < 0.05). There was no significant difference regarding recurrence rates (p = 1) and the final reduction rates (p = 0.51) between the two groups.

CONCLUSION

Percutaneous sclerotherapy is a minimally invasive technique, preserving maximum tissue while effectively treating NPSCs. Single-session sclerotherapy which reduces hospitalization days and increases patient comfort is as effective as multi-session sclerotherapy as the initial procedure. This study supports that single-session sclerotherapy should be a valid treatment option.

Successful percutaneous treatment of extrahepatic cystic echinococcosis through PAIR and single puncture catheter techniques

PURPOSE

To demonstrate the successful percutaneous treatment of extrahepatic cystic echinococcosis as an alternative to surgical procedures.

MATERIALS AND METHODS

A total of 27 extrahepatic hydatid cysts in 12 patients, the spleen in 8 patients, muscles and soft tissues in 3 patients each and right adrenal gland in 1 patient were treated with PAIR (puncture, aspiration, injection, respiration) or single puncture catheterization methods. As a scolicidal and sclerosing agent, alcohol was used in all patients.

RESULTS

Of 27 extrahepatic lesions of hydatid cysts, 24 (88.9%) were Gharbi type 1 (WHO CE 1), and 3 (11.1%) were Gharbi type 2 (WHO CE 3A). Of hydatid cystic lesions, 20 with PAIR and 7 with single puncture catheterization methods were treated. No major complications developed in any patients. Abscesses were detected in two patients (16.6%). Mean total hospital stay was calculated between 1 and 14 days (mean 2.3 days). Follow-up periods ranged between 10 and 62 months (mean 22.3 months).

CONCLUSION

Percutaneous treatment for extrahepatic hydatid cystic lesions is an important alternative to surgical procedures because of the high therapeutic success rate, lower rate of complications and shorter hospital stays.

The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease

The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.