A 48years old male patient presented with dry cough (since 9 days)and with no specific abdominal symptoms undergoing medical consultation was advised an X-ray of the abdomen, which revealed a well-defined, rounded soft-tissue opacity with calcified margins in the left hypochondrium.On examination, her vital parameters were within normal limits. Examination of the abdomen revealed no abnormality. Renal and liver function tests were within normal limits.He was then advised CT scan abdomen.
Findings:
CT Scan Of The Abdomen Showing A Well Defined Rounded hypodense Mass With Dense Calcification in the spleen.
Diagnosis:
Primary Hydatid Cyst Of The Spleen
Discussion:
Splenic hydatid disease is rare and the incidence is reported between 2-3.5% by different authors. Primary infestation of the spleen usually takes place by the arterial route after the parasite has passed the two filters (hepatic and pulmonary). A retrograde venous route, which bypasses the lung and liver, is also reported. Secondary splenic hydatid disease usually follows systemic disseminated or intraperitoneal spread following ruptured hepatic hydatid cyst.
The hydatid cyst consists of three layers. The outer adventitia is formed of compressed splenic tissue, a middle layer of friable ectocyst and an inner germinal layer from which a large number of scolices are produced.
Splenic hydatid cysts are usually asymptomatic but may present as a painful mass in the left upper quadrant. An enlarged spleen may be found. The complications of untreated splenic hydatid cyst are mainly infection, intraabdominal rupture and fistulization to the bowel, mainly colon. Rupture of splenic hydatid cyst into the thorax leading to splenothoracic fistula has also been reported. Severe anaphylactic reactions due to rupture of the cyst are also reported leading to fever, pruritus, dyspnea, stridor and edema of the face. Portal hypertension is also described with splenic hydatidosis.
The main differential diagnoses of splenic hydatidosis are splenic cystic lesions such as pseudocyst, abscess, haematoma and cystic neoplasm.
Eosinophilia may be the finding on hematological investigation. Marginal or crumpled eggshell-like calcifications in the splenic area on abdominal or chest radiograph are suggestive of splenic hydatidosis. Sonography may reveal a solitary unilocular lesion or rarely multiple well-defined anechoic spherical cystic lesions with hyperechoic marginal calcification in the spleen. Computed tomography may show the cystic lesion with or without the daughter cysts within the spleen with an attenuation value near that of water without any contrast enhancement.cyst Wall calcification is more clearly seen with CT of the abdomen.
Hydatid immunoelectrophoresis, enzyme linked immunoabsorbent assay (ELISA), latex agglutination and indirect haemagglutination test are the different serological tests for diagnosis, screening and follow-up for recurrence.
Splenectomy has been the traditional treatment of choice for splenic hydatid cyst. Laparoscopic approach has also been advocated for uncomplicated hydatid cyst of the spleen. Albendazole and or praziquantel are the drugs recommended for the treatment of this disease.
Surgical exploration was planned in our case which revealed hydatid cyst of the spleen .Splenectomy was done. The patient had an uneventful post-operative recovery and was discharged on the 10th post-operative day with a regimen of albendazole.
Histopathology of the specimen confirmed a hydatid cyst of the spleen
References / Suggested Reading:
1. Brown HW, Neva FA: Basic Clinical Parasitology, Ed 5, pp 191-8. Appleton-Century Crofts, 1983.
2. Ionescu A, Jakab A, Jutis T, Forai F, Ota A. Splenic hydatid cyst (Article in Romanian). Rev Med Chir Soc Med Nat Iasi 1990; 94:525-8.
3.Kiresi DA, Karabacakoglu A, Odev K, Karakoese S. Uncommon Locations of Hydatid Cysts. Acta Radiol 2003; 44: 622.
Thank you for this submission. It will be nice if you can upload plain film and non contrast CT of this patient.
Dr. Vikram Singh Dogra
Professor of Radiology, Urology & BME
Associate Chair for Education and Research.
Department of Imaging Sciences
University of Rochester School of Medicine
Dear Anshu:
Thank you for this submission. It will be nice if you can upload plain film and non contrast CT of this patient.
Dr. Vikram Singh Dogra
Professor of Radiology, Urology & BME
Associate Chair for Education and Research.
Department of Imaging Sciences
University of Rochester School of Medicine