Sonographically guided percutaneous treatment of hepatic hydatid cysts: long-term results.
OBJECTIVE
The purpose of this study was to evaluate the safety and efficacy of sonographically guided percutaneous drainage and irrigation of hepatic hydatid cysts.


METHODS
Sixty-one patients with 84 hepatic hydatid cysts were treated using the puncture, aspiration, injection, and reaspiration (PAIR) technique under sonographic guidance. Patients with cysts larger than 6 cm in diameter underwent PAIR followed by percutaneous drainage (PAIR-PD). The cysts were sterilized by the injection of 1 of 2 scolicidal agents, 20% hypertonic saline solution (38 patients) or 0.5% silver nitrate (23 patients). All patients underwent follow-up examinations for 1 month-6 years after aspiration. Clinical and radiologic examinations and laboratory analyses were performed every month for the first 6 months and then at 3-month intervals.


RESULTS
Serial sonographic examinations revealed a heterogeneous echo pattern in 78 cysts (93%); a progressive decrease in diameter in 76 cysts (90%); calcification of the cyst wall, cystic contents, or both in 10 cysts (12%); and complete disappearance of 1 cyst (1%) in a patient who had been monitored for over 6 years. Five patients developed urticaria, and 6 developed fever. One patient developed a biliary fistula after the first aspiration attempt. Two patients developed infection of the cyst cavity after PAIR-PD and were successfully treated with oral antibiotics. An anaphylactic reaction developed in 2 patients and was successfully treated with antiallergenic medication. No recurrence of hydatid disease after PAIR or PAIR-PD was observed in any patient over the follow-up period of 72 months (mean, 26 +/- 27 months).


CONCLUSIONS
Percutaneous drainage of hydatid cysts is a safe, effective, and reliable treatment. Antiallergenic medication is required before PAIR or PAIR-PD. Both sclerosing agents, hypertonic saline and silver nitrate solutions, gave excellent results.
Odev
K
K
Department of Radiology, Selçuk University, Faculty of Medicine, 42080 Konya, Turkey.
Paksoy
Y
Y
Arslan
A
A
Aygün
E
E
Sahin
M
M
Karaköse
S
S
Baykan
M
M
Arikoğlu
H
H
Aksoy
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000923:Anticestodal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001658:Biliary Fistula / Q000209:etiology; D002648:Child; D004155:Diphenhydramine / Q000627:therapeutic use; D004322:Drainage / Q000009:adverse effects; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005334:Fever / Q000139:chemically induced; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012835:Silver Nitrate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013396:Suction; D007507:Therapeutic Irrigation; D018084:Ultrasonography, Interventional; D014581:Urticaria / Q000139:chemically induced
D018926:Anti-Allergic Agents; D000923:Anticestodal Agents; D012462:Saline Solution, Hypertonic; D012597:Sclerosing Solutions; D004155:Diphenhydramine; D012835:Silver Nitrate