Intrabiliary rupture of hepatic hydatid cyst: multidetector-row CT demonstration

Abstract

Rupture of a hydatid cyst into the biliary tract, also known as cystobiliary communication, is the most common complication of hepatic hydatid cyst. This may lead to obstructive jaundice, pancreatitis, cholangitis, and sepsis with high mortality. Imaging plays an important role in the preoperative diagnosis of this condition which facilitates its management. We studied six patients with rupture of hepatic hydatid cyst into a large bile duct in whom multidetector-row CT (MDCT) suggested the diagnosis. The imaging findings included a single hepatic cyst less than 10 cm in diameter in all the cases; interruption of the cyst wall adjacent to a bile duct signifying cyst-bile duct communication was seen in five patients. The common bile duct was dilated in all the patients, with linear membranes in four and diffuse irregular high dense intrabiliary material observed within the common bile duct in two of them. Intrahepatic ducts were dilated in all the six cases and two patients showed linear dense contents within distended gallbladder. Subcapsular and intrathoracic rupture was associated in one patient each. MDCT demonstration of hydatid cyst in the liver together with a dilated common bile duct and distended gallbladder containing high density hydatid material suggest rupture of the cyst into biliary tree. MDCT enhances demonstration of the dilated common bile duct with hydatid material inside. The diagnosis is reinforced by the demonstration of the cystobiliary communication itself.

Role of endoscopic retrograde cholangiography in ruptured hepatic hydatid cyst

“…Three patients (25%) suffered filling defects within CBD in a study by Erden et al 8 The passage of cyst contents into the biliary tree also results in IHBRD. This is a common finding reported in all patients in the study by Wani et al 7 and 75% patients in the study by Erden et al 8 We also noted IHBRD in all our patients. Though sensitive, these findings can also be seen in the presence of blood, pus or sludge.…”

“…Wani et al found cyst wall irregularity in 3 out of 6 patients on MDCT. 7 Like cyst wall collapse, reduced intracystic pressure results in detachment of membranes seen as layered structures on USG/ CT/ MRI and filling defects on ERCP/ MRCP. We found evidence of detached membranes in 3 cases.…”

“…Wani et al reported pleural (n=1) and subcapsular rupture (n=1) in their MDCT evaluation of 6 cases. 7 Besides detection of communication, ERCP plays an important role in the management of these patients by decompressing the biliary tree. 9,10 Galati et al reported the utility of ERCP in management of patients with cystobiliary fistula.…”

“…7,8 However, ERCP has the advantage of biliary decompression and hence management of patients. 9,10 A combination of ERCP and a cross-sectional imaging technique represent the best method of evaluating patients with suspected intrabiliary rupture.…”

Complications of Hydatid Cysts of the Liver: Spiral Computed Tomography Findings

“…Therefore, a rapid and accurate pre-operative diagnosis is essential. CT is an imaging method which provides such diagnosis based on specific findings [ 8 , 16 ]. The discontinuity of the calcified or not hydatid cyst wall, the change in architecture of the cyst and the dilatation of the biliary tree with air or air-fluid level inside the cyst and the dilatation of the biliary tree with air or containing high density linear structures, representing hydatid material are characteristic imaging findings which can lead to the final diagnosis of the rupture [ 5 , 11 ].…”