Hepatic Echinococcal Cysts: A Review Pakala, Tina; Molina, Marco; Wu, George Y
Journal of clinical and translational hepatology,
2016-Mar-28, Volume:
4, Issue:
1
Journal Article
Open access
Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in ...certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5-10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.
Hepatic cysts (HCs) are frequently discovered incidentally on abdominal imaging. The prevalence of HCs has been reported as high as 15-18% in the United States. Although most cysts are benign, some ...are malignant or premalignant. It is important to diagnose cystic lesions in order to properly manage them. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to further characterize and diagnose HCs. Ultrasound is typically the first-line imaging modality, whereas more advanced imaging can help narrow down the specific lesion. Contrast-enhanced ultrasound is a newer modality, recently approved in the United States, which offers non-invasive evaluation in real-time. The first step in diagnosis is stratifying risk by differentiating simple and complex cysts. There are several features that can help identify HCs, including septae, mural consistency, calcifications, and quality of cystic fluid. Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma and other rare lesions. Treatment is indicated in symptomatic cysts or those suspicious for malignant or premalignant features. Treatment modalities include fenestration, aspiration sclerotherapy, or surgical resection.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus responsible for coronavirus disease 2019 (COVID-19).
The virus enters cells via the angiotensin-converting enzyme 2 ...receptor, which is present in enterocytes in the ileum and colon.
Gastrointestinal (GI) manifestations include diarrhea, nausea, vomiting, and abdominal pain, and the prevalence of GI symptoms varies greatly, with a range between 2% and 57%.
In addition, abnormal liver chemistries are reported commonly.
As a medical center at the forefront of the early epidemic in the United States, we seek to contribute to the growing body of literature that outlines the gastrointestinal and hepatic manifestations of COVID-19.
Abstract Background Absorbable metallic stents (AMS) composed of magnesium alloy were designed to complete degradation within 90–120 days. Among the potential advantages of these stents, when ...compared to conventional stents, are the elimination of late stent thrombosis, chronic inflammation, and artifacts during noninvasive imaging. Methods Magnesium-based AMS were deployed in juvenile domestic pig coronary arteries. Angiography, optical coherence tomography (OCT), and intravascular ultrasound (IVUS) were performed before and after implant and then at 28 days and 3 months following stenting. The animals were sacrificed at 28 days or 3 months following stent implantation. Stented vessels were harvested and analyzed by histomorphometry. Results Over time, OCT, IVUS, and histologic images revealed a progressive degradation of the stents. Mean stent strut width in the OCT images after implantation was 0.24±0.032 mm, then decreased to 0.12±0.007 mm ( P <.0001) at 28 days and to 0.151±0.032 mm at 3 months ( P <.0001 vs. implant, P =.078 vs. 28 days). Conclusion Magnesium-based AMS degrade over a 3-month time period in a porcine model. Its structure is not apparent by angiography but is well-visualized by OCT and IVUS. OCT allowed quantitative assessment of stent degradation.
PDF
