Case Report

Complicated Hydatid Cyst of the Liver: A Case of Hepato-Pulmonary Fistula

Authors: Sveva Lamorte, Gianfranco Belmonte, Gerardo Annarumma, Concetta Ciavarrella, Antonella Lotumolo, Alessandra Di Chiara, Rocco Tricarico, Alexis Zandolino, Serena Gallotta, Giovanna Fortunato, Gianluca D’Imperio, Mariangela Dicandia, Enrico Scarano.

DOI: 10.33425/2768-6647.1070

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Abstract

Cystic echinococcosis is the term commonly used name for the larval stage of the tapeworm in a zoonotic parasitic infection, caused by species of Echinococcus [1].

Infection can potentially occur in any organs and tissues of the human body but predominantly it can affect the liver (75%) and the lung (15%) [1]. Hydatid disease (HD) can remain asymptomatic, and many hydatid cysts (HCs) represent incidental clinical or radiological findings [2].

Presence of symptoms mostly depend on the site of involvement, stage of growth, mass effect, complications or hematogenous spread [3]; reason why different scenarios may occur.

Even if typical features of HD, especially hepatic no-complicated manifestations, are nowadays well known, imaging still plays a key-role not only to reach the fast and correct diagnosis, but also in the visualization of any complications, that are sometimes life-threatening conditions [4].

Ultrasound (US) is almost always the first approach for diagnosis, staging, differential diagnosis, leading any interventional management and usually the first choice during the follow-up [1].

Computed tomography (CT) best demonstrates cyst wall calcification and cyst infection [5].

CT and magnetic resonance (MRI) are furthermore indicated to detect cyst wall defects and also to identify the passage of contents through any fissures or transdiaphragmatic migration [5].

MRI remains superior in demonstrating any neural involvement [5]. The aim of this case report is to show one of the not-so-uncommon complications of this infection, meaning a complex hepatic cyst complicated by hepato-pleuralpulmonary fistula.

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