Hydatid cysts – symptoms, tests, treatment. Hydatid cyst is a cystic tumor that occurs in the liver (it can be located in lungs, kidneys, spleen, brain, bone, muscle, eye but with a much lower frequency) after infestation with the parasite called Taenia echinoccocus .
This condition occurs with a frequency approximately equal in both sexes and interests all ages. Professions most commonly affected are shepherds, butchers, farmers.
These groups of people have an increased risk of infection with this parasite because the source of parasites is represented by some carnivores (dogs, cats). The worm lives in their intestine in an adult state. Eggs are eliminated in feces and due to lack of hygiene (unwashed hands, unwashed vegetables) are eaten by herbivores and human who are intermediate hosts for the parasite development. In their intestines (herbivores and humans) is released the hexacanat embryo, at this level is circulated through the blood to the viscera where will develop the cystic larval form .
Most of embryos are retained in the capillary hepatic flow, at this level it’s fixed and give birth to hydatid cyst. The most affected is the hepatic right lobe.
Symptoms of liver hydatid cyst
The clinical presentation is polymorphous. Pretumoral phase is characterized by “small” signs syndrome which include: loss of appetite (decreased appetite), anorexia to fat, nausea, vomiting, diarrhea, epistaxis (nasal bleeding), pain or heaviness in the upper abdominal right side (where the liver is located) with irradiation in the back or shoulder, rash crisis.
In tumour stage symptoms depend on the location of the cyst.
Cysts with superior evolution give pleuro-pulmonary symptoms (dry cough, mild dyspnoea = shortness of breath, pain point that radiates to the right shoulder or stabbing). Also in the evolution of these cysts it can be seen some enlargement of the chest base.
Cysts with anterior development are clinically characterized by a slight feeling of heaviness or pressure in the right upper abdominal level, with radiation to the shoulder or intense pain. Sometimes this area can be bulged and at palpation can be seen either hepatomegaly (enlargement of the liver) or a distorted hepatomegaly.
Cysts with inferior evolution by compression on surrounding organs may give a series of phenomena of stenosis (compression on the stomach and duodenum), jaundice (in biliary compression), ascites (portal vein compression), swelling of the legs (compression vena cava).
Cysts with central developments give a regular hepatomegaly without other clinical signs, moving slowly.
Analysis of hydatid cyst
For diagnosis of this condition are required the following investigations:
Casoni IDR, antibodies anti-echinococus, X-ray (enlargement of the liver, changes in liver surface, diaphragm aspect), spleen and portal vein graphy (defines the image of the cyst), ultrasound, scintigraphy, blood counts (eosinophilia = increased eosinophils).
Evolution and complications of hydatid cyst
The liver hydatid cyst gradually increases in volume. In the evolution of the disease can occur serious complications:
– Compression of veins and hepatic ducts;
– Compression of neighboring organs;
– Cyst infection;
– Cyst rupture into neighboring organs or cavities is a serious accident and result in anaphylactic shock.
Hydatid cyst treatment
Treatment of hydatid cyst consists of medication (Albendazole) in young cysts or if the medical treatment fails is required surgery.
Bibliography: 1. Braunwald's Heart Disease; 2. Harrison's Principles of Internal Medicine; 3. European Society of Cardiology - Clinical Practice Guidelines.