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Four hundred forty-eight patients with 929 Echinococcus granulosus hydatid cysts received 3- to 6-month continuous cycles of mebendazole or albendazole treatment and underwent prolonged follow-up by clinical visits and imaging studies (range, 1–14 years) to assess the long-term outcome of treatment. Degenerative changes and relapse were assessed by imaging techniques. At the end of therapy, 74.1% of the hydatid cysts showed degenerative changes. These were more frequent in albendazole-treated than in mebendazole-treated cysts (82.2% vs. 56.1%; P < .001). During longterm follow-up, 104 cysts (22%) had degenerative changes that progressed, whereas 163 cysts (∼25%) relapsed. The percentages of relapses in the two drug-treated groups were almost the same. Relapses occurred more frequently in type II cysts of the liver. Cysts recurred most often (78.5%; P < .001) within the first 2 years after treatment ended. Further chemotherapy cycles induced degenerative changes in >90% of relapsed cysts without inducing more frequent or more severe side effects than those observed during the initial cycles.

Alveolar echinococcosis (AE) is a rare but severe zoonosis caused by Echinococcus multilocularis that predominantly affects the liver. While previous studies have focused on single ultrasound patterns, the significance of hepatic double pattern lesions is not yet fully understood. The aim of this study is to investigate the prevalence, characteristics and combinations of sonographic double patterns in AE. Based on data from Germany’s national echinococcosis database (n=825),40 patients with AE and confirmed double pattern were analysed retrospectively. Inclusion criteria were patients with at least two hepatic lesions of different patterns on reference ultrasound (US). US images were evaluated using the Echinococcosis Multilocularis Ulm Classification (EMUC)-US classification, with the analysis conducted by independent, blinded sonographers. Overall, a double pattern was detected in 4.8 % of patients (n=40). Ten different pattern combinations between two different patterns were observed, with the hailstorm and ossification patterns being the most common combination (52.2 %). Pattern combinations of up to four patterns were found in a single patient. A statistically significant correlation between the pattern combination and lesion activity, as determined by 18 FDG-PET/CT and serological markers, could not be demonstrated. Sonographic double pattern manifestations of AE are rare. Currently, the occurrence of specific patterns and their combinations does not correlate with lesion activity. Further studies with larger sample sizes are needed to better understand the significance of double patterns and their potential prognostic value.

We present the case of a 25-year-old male harboring multiple brain lesions mimicking tumor metastasis that were revealed to be caused by Echinococcus multilocularis. Cerebral echinococcosis with multiple lesions is rare and might be confused with a brain abscess, tuberculoma, or metastatic tumor disease. Brain magnetic resonance imaging and serological studies are helpful in the differential diagnosis. In case of E. multilocularis, cerebral invasion is the late stage of the disease that necessitates an aggressive treatment protocol.

BackgroundMinimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy should be evaluated for its feasibility and efficacy.AimPresent prospective study was designed to highlight the feasibility and utility of endoscopic approach in the management of complex hydatid cyst of the liver and spleen extending into the thorax.Material and methodsPatients undergoing combined Laparoscopy and thoracoscopy for abdominal hydatid cysts extending into thorax over a period of 4 years were included in the study. Their clinical features, investigations, imaging, treatment and duration of hospital stay were studied. Clinical outcomes were assessed with respect to morbidity and mortality using Calvien Dindo scale.ResultsA total of 15 patients were studied. All patients had thoracic hydatid cysts with liver involvement in 12, splenic involvement in 2, and both liver and spleen in 1 patient. The most common symptom was pain in the abdomen in 11 patients (73.3%) followed by lump in the abdomen in 2 patients (13.33%), and dyspnoea in 2 patients (13.33%). Computed Tomography was diagnostic in all patients. Most common type was Gomez type 1 (7 patients) followed by Gomez type II (3 Patient) and Gomez type III (2 patient). The mean operative time was 120 min. Mean hospital stay was 10 days. Pleural effusion being the commonest postoperative sequelae.ConclusionThis endoscopic approach for liver and splenic hydatid cyst extending into thorax is feasible and averts morbidities of thoracotomy.

PurposeThe aim of this study is to evaluate the efficacy of percutaneous treatment in hydatid cysts (HCs) with at least one diameter larger than 10 cm.Materials and methods58 CE1 or CE3a HCs with at least one diameter larger than 10 cm which were treated with catheterization between September 2016 and December 2021 were retrospectively analyzed.ResultsMean age was 40 ± 17.7 (18–80). Majority of HCs were in the liver (89.6%). Median follow-up was 28 months. Technical success rate was 100%; however, a second procedure was needed in 13 cysts due to recollection (n = 4), infection (n = 6), and recurrence (n = 3).ConclusionsGiant HCs can be effectively treated with catheterization with low complication rates.

This case report presents a 43-year-old worker (welder in the locksmith trade) from Bosnia and Herzegovina who was diagnosed with advanced hydatidosis during a preventive medical examination. The patient had a history of frequent close contact with dogs at home and at work and reported a long-standing sensation of heaviness in the left side of his abdomen. As part of his routine occupational health examination, he had a complete laboratory testing, abdominal ultrasound, multislice computed tomography (MSCT), and a consultation with an infectious disease specialist and abdominal surgeon. Imaging revealed multiple cystic formations in the left hemiabdomen and a cyst in segment VIII of the liver, confirming the diagnosis of multivisceral echinococcosis. The patient was promptly treated with preoperative (and postoperative) albendazole to reduce the cyst size and prevent complications. This case highlights the critical role of ultrasound in the diagnosis of hydatidosis, especially in an occupational medicine context. As part of preventive screening, ultrasound is a valuable tool for the early detection of echinococcosis in workers in high-risk environments. Early diagnosis allows for timely intervention, reducing the risk of disease progression to an advanced stage. This case underscores the importance of implementing effective epidemiological strategies, including regular screenings and awareness campaigns, in order to control the spread of echinococcosis in endemic regions.

Objective : To propose a modification of the Kodama classification to classify type III lesions of alveolar echinococcosis (AE) that do not have microcysts. Materials and Methods : 200 magnetic resonance imaging (MRI) images of AE liver lesions from four endemic regions of the world were classified according to Kodama, distinguishing within type III those with microcysts from those without. Each center included 50 MRIs of patients with unoperated AA liver lesions. The first 50 cases were classified by a first reader in the presence of four second-line readers from each region. Then each second-line reader classified his or her 50 cases. Results : In all centers, type III lesions were predominant: 58% of the total lesions and 23% of them were without microcysts. The average age of the patients was 47 years. In China, the patients were on average younger and the lesions larger. German patients had more lesions within the liver. Type I and II lesions, synonymous with earlier diagnosis, were more common in Europe. Conclusion : The Kodama classification needed to be modified because of the existence of a significant proportion of unclassifiable lesions. This is especially true since the presence of microcysts is an informative element of parasite activity. Therefore, this study proposes a Kodama-XUUB classification with type IIIa lesions having microcysts and type IIIb lesions not having microcysts. Objectif : Proposer une modification de la classification de Kodama permettant de classer les lésions de type III qui ne présentent pas de microkystes. Matériels et Méthodes : 200 IRM de lésions hépatiques d’EA en provenance de quatre régions d’endémie dans le monde ont été classées selon Kodama, en distinguant au sein du type III celles qui présentaient des microkystes de celle qui n’en présentaient pas. Chaque centre a inclus 50 IRM de patients avec lésions hépatiques d’EA non opérées. Les 50 premiers cas ont été classés par un premier lecteur en présence des quatre seconds lecteurs issus de chacune des régions. Puis chaque second lecteur a classé ses 50 cas. Résultats : Dans tous les centres, les lésions de type III étaient largement prédominantes : 58 % du total des lésions et 23 % d’entre elles ne présentaient pas de microkystes. La moyenne d’âge des patients était de 47 ans. En Chine, les patients étaient en moyenne plus jeunes et les lésions plus larges. Les patients allemands présentaient plus de lésions au sein du foie. Les lésions de type I et II, synonymes de diagnostic plus précoce étaient plus fréquentes en Europe. Conclusion : La classification de Kodama nécessitait d’être modifiée du fait de l’existence d’une proportion non négligeable de lésions non classifiables. Ce d’autant que la présence de microkystes est un élément informatif de l’activité du parasite. C’est pourquoi cette étude propose une classification Kodama-XUUB avec un type IIIa de lésions avec microkystes et un type IIIb sans microkystes.

The co-occurrence of hepatic cystic echinococcosis (CE) and alveolar echinococcosis (AE) is extremely rare. Here, we present the clinical manifestations and treatment outcomes of three cases with co-occurring CE and AE in the liver. Computed tomography (CT), magnetic resonance imaging and 18F Fluorodeoxyglucose Positron Emission Tomography-CT were used for preoperative diagnosis. Specimens were taken intraoperatively and sent for pathological studies to confirm the coexistence of CE and AE by laminated membrane, daughter cysts or germinal layer and infiltration structure. Albendazole was prescribed after operation for 12 months. All patients were completely recovered and showed no recurrence at last follow-up. Therefore, surgical intervention and postoperative application of albendazole are recommended for patients with concurrence of hepatic AE and CE.