title: Clinical characterization of unusual cystic echinococcosis in southern part of Turkey.
abstract: OBJECTIVE
  The incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients.
  
  
  METHODS
  A retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcal Hospital.
  
  
  METHODS
  Among the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis.
  
  
  RESULTS
  Of 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases.
  
  
  CONCLUSIONS
  CE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.
authors.forename: Atlgan Tolga
authors.initials: AT
authors.lastname: Akcam
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ulku
authors.affiliation: Ismail Soner Koltas, PhD, Department of Parasitology,, Cukurova University, Balcali,, Adana 01330, Turkey, T: +903223386060 F: +903223386572, koltas@cu.edu.tr.
authors.forename: Ismail Soner
authors.initials: IS
authors.lastname: Koltas
authors.forename: Volkan
authors.initials: V
authors.lastname: Izol
authors.forename: Omer Sunkar
authors.initials: OS
authors.lastname: Bicer
authors.forename: Emine
authors.initials: E
authors.lastname: Kilicbagir
authors.forename: Gurhan
authors.initials: G
authors.lastname: Sakman
authors.forename: Hakan
authors.initials: H
authors.lastname: Poyrazoglu
authors.forename: Tahsin
authors.initials: T
authors.lastname: Erman
authors.forename: Ibrahim Atilla
authors.initials: IA
authors.lastname: Aridogan
authors.forename: Cem Kaan
authors.initials: CK
authors.lastname: Parsak
authors.forename: Mehmet
authors.initials: M
authors.lastname: Inal
authors.forename: Serdar
authors.initials: S
authors.lastname: Iskit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002494:Central Nervous System Infections / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D004443:Echinococcosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D004444:Echinococcosis, Hepatic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004445:Echinococcosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014421:Turkey; D055815:Young Adult