Splenic Hydatid cyst - A case report
Splenic Hydatid cyst
The patient presented to the emergency department with complaints of abdominal pain for 6 months. The pain was confined to the upper left quadrant of the abdomen and was continuous and dull aching in nature.
On examination she was pale and afebrile, not icteric or cyanotic. Her Pulse rate(PR) was 78/min and Blood pressure(BP) was 130/90 mm Hg. On systemic examination her cardiac and respiratory systems were normal. Per abdominal examination revealed a soft abdomen with mild tenderness in left hypochondrium and epigastric region. No guarding or rigidity. Investigations like complete blood count, liver function tests, renal function tests and serology was carried out. The patient was found to be Hepatitis B Surface antigen (Hbsg) positive. The patient was referred to the Radiology Department for further evaluation. Ultrasonogram(USG) abdomen was done for the patient. USG abdomen revealed a well defined multicystic lesion measuring 7.5 x 6.0 cms with thick internal septations in spleen[Fig 1]. The patient was subjected for Computed Tomography(CT) examination. Non enhanced CT Abdomen revealed a well circumscribed oval hypodense multicystic lesion measuring 7.9 x 6.2 cms with internal septations showing the spoke wheel pattern in the substance of spleen. A thin focal rim of calcification is noted in the periphery of the lesion[Fig 2,3]. Magnetic resonance imaging(MRI) was performed for the patient. T1 and T2 weighted MRI demonstrated a well defined multicystic lesion with well defined capsule and a hypointense rim on T2 which is characteristic of hydatid [Fig 4 and Fig 5]. Other abdominal organs were found to be normal. The final diagnosis of hydatid disease of spleen was given based on the above imaging findings. Splenectomy was performed for the patient and proved to be hydatid cyst. Gross splenectomy specimens[Fig 6] and cut specimen of spleen showing multiple fluid filled vesicles[Fig 7]
The word hydatid is of Greek origin and it means a drop of water. Hydatid disease is endemic in middle east, India, Australia, South America, New Zealand. Hydatid disease is a parasitic infestation by a tapeworm Echinococcus granulosus. Infestation with Echinococcus granulosus is prevalent especially in villages where sheep, dogs, and other cattles live in close contact with humans. Dogs and other members of canine family are the hosts of the parasite. The definitive hosts are cattles and dogs whereas the humans are the accidental hosts because they are usually a dead end for the parasitic infection cycle. Humans may contract infection either by direct contact with dog or by ingestion of fluid or food contaminated with the faeces of dogs. The most common organ affected by the parasite is the liver and the lungs followed by the other organs like kidney, brain and bones[1,2]. The least common organs to be affected are the spleen, pancreas and the muscles. The splenic involvement represents 5% of cases.
Unilocular or a multilocular cystic lesion should raise the suspicion of hydatid cyst, pariticularly in places where it is endemic and hydatid cysts can occur in unusual locations as well. Splenic hydatid cysts are usually solitary and occurs as a result of either systemic dissemination or intraperitoneal spread from a ruptured hepatic hydatid cyst.