Hepatic echinococcosis complicated with transphrenic migration and bronchial fistula: CT demonstration

Abstract

An unusual case of hepatic hydatidosis complicated by transphrenic migration of the hydatid cyst passing through the right hemidiaphragm, and penetrating the inferior pulmonary lobe causing a bronchial fistula, is presented. The computed tomographic (CT) study permitted the correct preoperative diagnosis.

Diaphragmatic or transdiaphragmatic thoracic involvement in hepatic hydatid disease: Surgical trends and classification

“…Diagnosis of hepatic hydatid disease has changed as a result of technologic innovations. At present it is based on ultrasonography, CT scans, and more recently MRI [11]. Techniques such as laparoscopy, liver scintigraphy, and even serologic tests have taken a secondary place.…”

“…Techniques such as laparoscopy, liver scintigraphy, and even serologic tests have taken a secondary place. Suspicion of diaphragmatic or pleuropulmonary involvement can be initiated by simple chest radiography and is confirmed with CT or MRI [11].…”

“…Diaphragmatic or transdiaphragmatic (pleuropulmonary) thoracic involvement by hydatid cysts in the hepatic dome ranges from 0.6% to 16.0% of all cases of hepatic hydatid disease [3,5,6,9,[11][12][13]. The progressive growth of the cysts, their tendency to erode the organs and tissues with which they come into contact, their infection, and the existence of negative intrathoracic pressures could explain the unusual evolution of some of the cysts located in the hepatic dome [8,9,11]. The damaging effect of the cyst on the diaphragm progresses with time, developing from mere adherence to perforation.…”

“…Although total closed cystectomy can be performed on many patients with D-TD involvement [1], when the size of the cyst prevents adequate control of the hepatic veins or inferior vena cava [6,7] open technique should be used. In the event of partial cystectomy, resection of the pericyst membrane should be performed as widely as possible and should not be confined to the aperture and drainage of the cavity, as others have proposed [6,7,11]. This approach reduces morbidity and the postoperative hospital stay and can be performed easily with modern electroscalpels [1].…”

Amebic abscess of the liver manifested by “hemoptysis”: US, CT, and MRI findings

“…Rupture through the diaphragm into the pleural cavity results in empyema. However, the multicystic aspect and the presence of calcifications in the liver mass will suggest Echinococcosis, and a positive serology will confirm the diagnosis [13,14]. In our case, this was believed to be hemoptysis.…”