A simple sonographic scoring system combined with routine serology is useful in differentiating parasitic from non-parasitic cysts of the liver

Abstract

KEYWORDSEchinococcosis; Cyst; Ultrasound.Abstract In the absence of a detached endocyst, unilocular echinococcal cysts of the liver may be difficult to distinguish from non-parasitic cysts. In an attempt to identify sonographic features that could help distinguish these two types of cysts, we retrospectively analyzed 64 cases of fluid-filled hepatic cysts whose parasitic nature was ultimately excluded. This experience allowed us to develop a simple scoring system that quantifies the likelihood that hepatic cysts are non-parasitic. Sonographic criteria, together with the results of standard serological testing for cystic echinococcosis, proved to be sufficiently specific to allow definitive diagnosis without resorting to further tests.Sommario In assenza di distacco dell'endocistio, le cisti epatiche da echinococco uniloculari, possono essere difficili da distinguere dalle cisti non parassitarie. Allo scopo di definire meglio le caratteristiche ecografiche che possano aiutare a distinguere questi due tipi di cisti, abbiamo esaminato retrospettivamente 64 casi di cisti epatiche a contenuto liquido, che si sono rivelate essere non parassitarie. Abbiamo quindi realizzato un sistema a punteggio in grado di predire la probabilità di una cisti di essere non parassitaria. In conclusione, i criteri ecografici associati ai i test sierologici per echinococcosi sono sufficientemente specifici per ottenere una diagnosi, senza ricorrere ad ulteriori indagini. ª

Cystic Neoplasms of the Liver: Biliary Cystadenoma and Cystadenocarcinoma

“…Their criteria included border irregularity, irregular shape, calcification, gender, ultrasound appearance at follow up and presence of septa (Figure 4A) . (60) Liver abscesses typically have a septated or multilocular appearance along with irregular thicker wall, albeit thicker than that seen with BCT (Figure 4B) . (43, 52, 59) The combination of imaging characteristics and serologic analysis along with culture of cyst fluid can aid in making an accurate diagnosis.…”

“…Echinococcal cysts present with debris or daughter cysts within the cysts. (59) Grisolia and colleagues (60) reliably differentiated non parasitic cysts from Echinococcal cysts without utilizing FNA by developing sonographic criteria in conjunction with routine serology. Their criteria included border irregularity, irregular shape, calcification, gender, ultrasound appearance at follow up and presence of septa (Figure 4A) .…”

Current status of diagnosis and treatment of hepatic echinococcosis

“…The WHO classification includes cysts of unknown origin and includes modified subtypes of the Types 2 and 3 cysts[ 14 ]. There are three categories of cysts: Active, transitional, and inactive[ 27 ]. Types 1 and 2 cysts are considered “active” while Type 3 cysts are considered “transitional”.…”

Ultrasound of echinococcal liver cysts

“…CE4 and CE5 are inactive cysts that have lost their fertility and are degenerating. A more recent amendment to the WHO classification clarifies that calcifications are not limited to CE5 cysts, but may be present to a various extent in all cystic stages and are therefore not indicative of cyst death [6]. B-mode hepatic sonogram shows well shaped large rounded hyperechoic solid appearing mass with inside appears of multiple hypoechoic curvilinear echoes clustered within mass without daughter cysts ( Figure 1).…”

“…It is suggestive for consolidating inactive hydatit cyst (the patient was under 3 months therapy with Albendazole, day dose 12 mg/kg). Shams-Ul-Bari et al (2011) conclude that albendazole is an effective adjuvant therapy in the treatment of hydatid liver disease [6,7] (Figure 1). …”