SHM Converge Scientific Abstract ePoster Gallery-Cease and De-Cyst: Coordinating Care in Extensive Hydatid Disease

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A 34-year-old man from Afghanistan, who had immigrated from Pakistan two years earlier, presented with three months of right upper quadrant pain, bloating, and exertional dyspnea, along with edema and scrotal swelling. He reported a history of prior “cysts” after exposure to contaminated water in an endemic setting, and had undergone liver and lung surgeries about 10 years earlier without receiving anti-parasitic treatment.<br /><br />Laboratory tests showed cholestatic liver abnormalities and low albumin. Imaging revealed a large right posterior-inferior mediastinal fluid collection, additional cystic collections near the right costophrenic angle, ascites, and cardiac compression with both atria compressed by a cyst. Given the patient’s epidemiologic risk, prior surgeries, and imaging findings, hydatid disease from Echinococcus granulosus was strongly suspected. Echinococcus IgG later returned positive.<br /><br />He underwent right thoracotomy with cystotomy, capitonnage, and cystectomy of a mediastinal hydatid cyst. Albendazole was started 24 hours before surgery, and postoperative praziquantel was given to reduce the risk of anaphylaxis or dissemination if cyst contents spilled. Cultures and ova/parasite studies were negative, but pathology confirmed echinococcal cyst wall with germinal layer and protoscolices. Additional staged hepatobiliary surgery was planned for remaining abdominal and subdiaphragmatic cysts.<br /><br />The case highlights how recurrent hydatid disease can result from incomplete prior treatment and the importance of detailed history-taking, immigration and exposure assessment, and multidisciplinary coordination among hospital medicine, infectious disease, thoracic surgery, and hepatobiliary surgery. It also illustrates that management must be individualized when guidelines are inconsistent, especially in urgent cases with major cardiopulmonary compromise and high operative risk.

Asset Subtitle

Kyle James

Meta Tag

Author List Brian Douglass, Daniel J. Gromer, Eszter Toth, Henry Wu, Kyle James, Laurence Balter, Matthew Collins, Puja Sasankan

Category Clinical Vignettes

Concept Hepatic Echinococcosis

Concept Echinococcus granulosus

Concept Clinical Presentation

Concept Imaging Finding

Concept Diagnostic Testing

Distinguished Non-Finalist

Presenter Organization Emory University Hospital Midtown

Presenting Author Kyle James

Track Adult

Keywords

hydatid disease

Echinococcus granulosus

mediastinal cyst

thoracotomy

albendazole

praziquantel

echinococcal cyst

immigration history

cardiac compression

multidisciplinary management

Hepatic Echinococcosis

Echinococcus granulosus

Clinical Presentation

Imaging Finding

Diagnostic Testing