Diagnosis and treatment of hepatic hydatid cysts with the aid of echo-guided percutaneous cyst puncture.

The usefulness of echo-guided percutaneous cyst puncture in the diagnosis and treatment of hepatic hydatid cysts was assessed in a study of 45 patients referred to the Department of Tropical Medicine at Kasr El Aini Hospital in Cairo. All subjects had at least one hepatic cyst detected by ultrasonography (54 cysts in all), and 42 patients had positive results in serological tests for antibodies to Echinococcus granulosus. The majority of cysts were in the right hepatic lobe (40 cysts), were anechoic (51), and were rounded and smooth (49). All 45 active cysts (44 anechoic, rounded, and smooth; one anechoic and septated) yielded clear watery fluid containing scolices and exhibited elevated pressure on percutaneous puncture. In contrast, all nine inactive cysts yielded cloudy yellowish fluid without detectable scolices and did not display elevated pressure on puncture. The latter cysts were anechoic and elliptical (two cysts); anechoic and septated (one); anechoic with a calcified wall (one) or a detached germinal layer (two); or rounded with coarse echoes (three). Treatment by injection of a scolicidal agent (hypertonic saline) before withdrawal of the needle used for aspiration gave excellent results and was not associated with complications. Forty-three of the 45 patients had no clinical or ultrasonographic evidence of recurrent or new hepatic cysts after 3 years of follow-up.