Hydatid disease presents as hydatid cysts primarily in the liver. Although hepatic hydatid cysts may be asymptomatic for many years, they may be symptomatic because of its complications such as expansion, rupture, and pyogenic infection. Rupture of the hepatic hydatid cysts into the biliary tract is one of the most serious complication and is frequently related to over enlargement of the cyst. Patients with this disease usually have pain or jaundice. In this paper, we present radiological imaging findings of an hepatic hydatid cysts ruptured into left main intrahepatic biliary duct presented as the acute right upper quadrant pain and jaundice. A 64-year-old man was admitted to the emergency department for suddenly onset of right upper quadrant pain and jaundice. Abdominal ultrasonography showed that cystic lesion measuring about 7x4 cm in diameters with lobulated contour adjacent gallbladder and communication between cyst and left main intrahepatic biliary duct. Abdominal computed tomography confirmed this findings and the patient surgically treated with pericystectomy and confirmed CT findings intraoperatively. The post-operative course was uneventful. Intrabiliary rupture of hepatic hydatid cysts must be considered in the differential diagnosis of patients presenting with right upper quadrant pain in areas where the disease is endemic. Early diagnosis with ultrasound, CT and appropriate treatment are essential for favorable outcome.
Özet
Kist hidatik primer olarak karaciğerde görülen parazitik bir hastalıktır. Hidatik kistler uzunca bir süre asemptomatik kalabilmelerine rağmen, rüptür ya da piyojenik infeksiyon gibi komplikasyonlarına bağlı olarak semptomatik olabilirler. İntrabilier rüptür karaciğer kist hidatiğinin en ciddi komplikasyonlarından biridir. Hastalar genellikle ağrı ve sarılık şikayetiyle başvururlar. Bu yazıda akut sağ üst kadran ağrısı ve sarılıkla başvuran karaciğer kist hidatik intrabilier rüptürünün radyolojik görüntüleme bulgularını sunmayı amaçladık. Altmış dört yaşındaki hasta ani başlayan sağ üst kadran ağrısı ve sarılık şikayetiyle acil servise başvurdu. Batın ultrasonografisinde karaciğer sol lob medial segmente 7x4 cm boyutlu lobule konturlu, basınçlı görünümünü kaybetmiş olan ve sol ana safra kanalı ile ilişkili hidatik kist ile uyumlu lezyon saptandı. Sagittal reformat çok kesitli bilgisayarlı tomografide kistin safra yolları ile ilişkisi net biçimde izlendi. Olgu opere edildiğinde çok kesitli bilgisayarlı tomografide bulguları teyit edildi. Hastalığın endemik olduğu bölgelerde sağ üst kadran ağrısı ile başvuran hastalarda karaciğer kist hidatiğinin safra yollarına rüptürü ayırıcı tanıda akılda bulundurulması gereken bir durumdur. Olguların çoğunluğunda ultrasonografi tanı için yeterli olmakla birlikte çok kesitli bilgisayarlı tomografide rüptür lokalizasyonunu göstermede oldukça faydalıdır.
Anahtar sözcükler: Ekinokokkozis, hepatik, spiral bilgisayarlı tomografi
Abstract
Hydatid disease presents as hydatid cysts primarily in the liver. Although hepatic hydatid cysts may be asymptomatic for many years, they may be symptomatic because of its complications such as expansion, rupture, and pyogenic infection. Rupture of the hepatic hydatid cysts into the biliary tract is one of the most serious complication and is frequently related to over enlargement of the cyst. Patients with this disease usually have pain or jaundice. In this paper, we present radiological imaging findings of an hepatic hydatid cysts ruptured into left main intrahepatic biliary duct presented as the acute right upper quadrant pain and jaundice. A 64-year-old man was admitted to the emergency department for suddenly onset of right upper quadrant pain and jaundice. Abdominal ultrasonography showed that cystic lesion measuring about 7x4 cm in diameters with lobulated contour adjacent gallbladder and communication between cyst and left main intrahepatic biliary duct. Abdominal computed tomography confirmed this findings and the patient surgically treated with pericystectomy and confirmed CT findings intraoperatively. The post-operative course was uneventful. Intrabiliary rupture of hepatic hydatid cysts must be considered in the differential diagnosis of patients presenting with right upper quadrant pain in areas where the disease is endemic. Early diagnosis with ultrasound, CT and appropriate treatment are essential for favorable outcome.
Keywords: Hydatid cyst, hepatic, spiral computed tomography
Primary Language | Turkish |
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Journal Section | Case Reports |
Authors | |
Publication Date | March 22, 2013 |
Published in Issue | Year 2013Volume: 35 Issue: 1 |