A 75-year old female was referred to her daughters physician, by her daughter, after complaining of what was described as nausea accompanied with right upper quadrant and epigastric abdominal pain and discomfort.
The past medical history as provided by her daughter was notably insignificant. She had no history of past medical illnesses or procedures to her knowledge. Her travel history was significant in that she had recently immigrated from her native Greece where she had been living on her family’s small farm for all her life. On this farm the family raised sheep and notably the farm had a number of dogs which were free to roam. Her physical examination was significant for tenderness of the right upper quadrant and a palpable abdominal mass. She was referred to a hospital for further testing and routine blood work was ordered (complete blood count & serum electrolytes) with the addition of a hepatic function panel.
The blood work had some abnormal results that had the attending physician suspect a specific disease process. Those results were an elevation in peripheral eosinophils and a slight elevation of her hepatic enzymes. An MRI of the abdomen was performed with contrast that revealed a low density cystic mass measuring 12 by 12 by 11 cm in the right lobe. The cystic mass was described as having a thick irregular wall composition. A Radiological and Infectious Disease Physician consult was sought.
A laparoscopy was ordered and performed on the second day of admission to the hospital. A cystectomy was performed and considering the suspicion of disease, was performed with special precautions to assure that the spread of the disease or any complications were minimized.
The cyst drainage collected from the cystectomy was fairly clear and colorless. It was sent to the laboratory for microscopic examination. It was significant for the following (see image below).
Serological tests that were ordered by the Infectious Disease Physician at the hospital further confirmed the suspected diagnosis.
Answer the following questions pertaining to this case study
Considering the clinical history of the patient (travel history and clinical presentation) and the image seen in the aspirated cyst fluid, what is your diagnosis?
What is the primary reservoir of this organism and how is it acquired by humans?
Are humans a normal part of this organisms life cycle?
What are you seeing in the image?
Why is it important to take care that the contents of the cyst are not expelled into the surrounding area?
What are the most common areas of the body in which this disease becomes established?
How is this disease normally treated?
It seems hydatid cyst (dogs are reservoir), that need to be carefully handled to avoid anaphylaxis reaction to cyst content during operation. It is treated medically (Albendazazole) with some indications for injection/aspiration, or surgical intervention. It can affect liver as well as lung and brain.
Very good Abdulrahim! You must have had some experience with a similar case?