title: Hydatidosis of the liver and posterior mediastinum.
abstract: BACKGROUND
  Cystic echinococcus (CE) is an endemic zoonosis secondary to infection by the larval form of the cestode Echinococcus granulosus. An intermediate host, humans enter the organism's life cycle by exposure to infected canid feces. The liver is the most common location of CE while mediastinal hydatid cysts are rarely reported.
  
  
  METHODS
  We report a case of synchronous CE of the liver and posterior mediastinum treated sequentially using chemotherapy, percutaneous aspiration with injection of a scolicidal agent and re-aspiration (PAIR) and then staged minimally-invasive surgeries.
  
  
  CONCLUSIONS
  Synchronous CE involving the liver and posterior mediastinum is rare. The treatment of hydatid liver and mediastinal disease is multimodal including chemotherapy, percutaneous and laparoscopic or open surgical interventions. One option for controlled puncture of hepatic and mediastinal CE includes PAIR followed by surgery.
  
  
  CONCLUSIONS
  The sequential use of chemotherapy and PAIR followed by surgery provides another treatment strategy for management of CE. We believe this strategy may be used safely in locations without endemic CE, including most regions of the United States.
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. Electronic address: jacob.quail@med.navy.mil.
authors.forename: Jacob F
authors.initials: JF
authors.lastname: Quail
authors.affiliation: Department of Cardiothoracic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Gramins
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Dutton
keywords: Cystic echinococcus; Hydatid cyst; Percutaneous aspiration with injection of a scolicidal agent and re-aspiration (PAIR)