9.3 Echinococcus cyst 

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The disease is caused by a parasite with the shape of a small tapeworm: usually Echinococcus granulosus. It is a parasite of dogs and foxes. Humans can be infected by ingesting contaminated food, such as blueberries, blackberries and insufficiently washed vegetables. The incubation period can last years. The parasite migrates from the intestine via the portal vein to the liver. There it forms a hydatid cyst, the inner wall of which is covered with multiple embryonic tapeworm heads. The outer wall of the cyst can calcify. The echinococcus cyst usually occurs solitary in the right lobe of the liver. Multiple cysts are possible in 30% of cases.

The liver cyst can cause pain in the right hypochondrium and can lead to hepatomegaly. Rupture of the cysts to the bile ducts can occur in 20% of cases, resulting in painful jaundice. Echinococcus multilobularis is a more aggressive parasite that also has localizations in the lungs. It can give an image of a primary liver neoplasm in the liver. The diagnosis is made on the basis of CT or MRI scan. Biochemically there is eosinophilia and the diagnosis can be made on the basis of serology. Treatment consists of surgical resection with pre- and postoperative administration of mebendazole or albendazole. In that case, a cystectomy is performed, in which the germinative layer of the echinococcal cyst is resected after intraoperative sterilization of the contents with hypertonic sodium chloride, to prevent dissemination.

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