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Clinical Images  |   June 2014
Hepatic Cystic Echinococcosis
Author Notes
  • From the Department of Surgery (Dr Koep) and the Department of Infectious Diseases (Dr Yu) at Banner Good Samaritan Medical Center in Phoenix, Arizona, and the Midwestern University/Arizona College of Osteopathic Medicine in Glendale (Dr Jensen). Dr Lloyd was a medical student at Midwestern University/Arizona College of Osteopathic Medicine at the time of presentation 
  • Address correspondence to Lauritz A. Jensen, DA, Midwestern University/Arizona College of Osteopathic Medicine, 19555 N 59th Ave, Glendale, AZ 85308-6813. E-mail: ljense@midwestern.edu  
Article Information
Gastroenterology / Imaging / Clinical Images
Clinical Images   |   June 2014
Hepatic Cystic Echinococcosis
The Journal of the American Osteopathic Association, June 2014, Vol. 114, 505. doi:10.7556/jaoa.2014.069
The Journal of the American Osteopathic Association, June 2014, Vol. 114, 505. doi:10.7556/jaoa.2014.069
Web of Science® Times Cited: 2
A woman presented to her family physician in summer 2012 with worsening right upper quadrant pain and nausea, unrelated to food intake, of 3 months duration. Additional history included a weight loss of 8 lb over the past month and no recent travel. The patient reported that she had immigrated to the United States from Uzbekistan in 1995 and that she was exposed to feral dogs in her homeland. 
Physical examination revealed no jaundice or palpable Murphy sign. Computed tomography of the abdomen (not pictured) revealed 2 complex lesions measuring 53 mm × 59 mm × 61 mm and 34 mm × 39 mm × 43 mm, with invasion to the right hepatic duct and vein. The cystic lesions were morphologically associated with thin internal septae and peripheral calcifications, consistent with hepatic cysts caused by Echinococcus granulosus.1 Enzyme-linked immunosorbent assay findings were positive for serologic echinococcus IgG; however, a follow-up immunoblot test performed at the Centers for Disease Control and Prevention did not confirm these findings.2 Fine-needle aspiration biopsy revealed protoscolices (independent pathologic confirmation). The patient was prescribed albendazole prophylactic therapy (400 mg twice daily) to minimize the risk of secondary echinococcosis. Six months later, the patient was referred for surgical resection, which she tolerated well without complications.3 The excised and transected inked cyst containing viable protoscolices is shown in the image. 
Acknowledgment
We thank William R. Finch, MD, for his invaluable suggestions during the preparation of this article. 
   Financial Disclosures: None reported.
 
   Support: None reported.
 
References
Czermak BV, Akhan O, Hiemetzberger Ret al. Echinococcosis of the liver. Abdom Imaging. 2008;33(2):133-143. [CrossRef] [PubMed]
Zhang W, Wen H, Li J, Lin R, McManus DP. Immunology and immunodiagnosis of cystic echinococcosis: an update [published online December 25, 2011]. Clin Dev Immunol. 2012;2012:101895. doi:10.1155/2012/101895. [PubMed]
Khuroo MS, Wani MA, Javid Get al. Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med. 1997;337(13):881-887. doi:10.1056/NEJM199709253371303. [CrossRef] [PubMed]