*4.2.4 Endoscopic retrograde cholangiography*

The rupture of a hydatid cyst in the intrahepatic bile duct can initiate some complications, which might become serious mainly due to the development of

**Figure 5.** *Unilocular cyst (CE1, white arrow). Detached membrane. Cyst (CE2, white star).*

**Figure 6.** *Contrast-enhanced CT. Septated cyst (white arrow).*

**Figure 7.** *Daughter vesicles in mother cyst (white arrow).*

**Figure 8.** *Coronal contrast-enhanced CT. CE3 A, water-lily sign (white arrow).*

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**Figure 12.**

treatment [40].

cholangitis and septicemia. In these cases, the ERC provides the diagnosis and performs the removal of hydatid material, with the objective of improving the general conditions of the patient before carrying out the definitive surgical

*MRI T2 axial. Detached membranes. Hypointense pericyst (white arrow). Water-lily sign.*

*(A) US content, heterogeneous with a solid appearance (CE4). (B) In the same patient, the contrast-enhanced* 

*Surgical Treatment of Hepatic Hydatidosis DOI: http://dx.doi.org/10.5772/intechopen.86319*

*Dome location with annular calcification (CE 5, white arrow).*

**Figure 10.**

**Figure 11.**

*CT diagnoses an unilocular hydatid cyst (CE1).*

**Figure 9.** *Central matrix. Daughter vesicles. Cartwheel sign (white arrow).*

*Surgical Treatment of Hepatic Hydatidosis DOI: http://dx.doi.org/10.5772/intechopen.86319*

*Liver Disease and Surgery*

**Figure 7.**

**Figure 8.**

*Daughter vesicles in mother cyst (white arrow).*

*Coronal contrast-enhanced CT. CE3 A, water-lily sign (white arrow).*

*Central matrix. Daughter vesicles. Cartwheel sign (white arrow).*

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**Figure 9.**

#### **Figure 10.** *Dome location with annular calcification (CE 5, white arrow).*

#### **Figure 11.**

*(A) US content, heterogeneous with a solid appearance (CE4). (B) In the same patient, the contrast-enhanced CT diagnoses an unilocular hydatid cyst (CE1).*

cholangitis and septicemia. In these cases, the ERC provides the diagnosis and performs the removal of hydatid material, with the objective of improving the general conditions of the patient before carrying out the definitive surgical treatment [40].

**Figure 13.**

*MRI T2 axial. Detached membranes (white star). Hydatid membranes in bile duct (white arrow).*

**Figure 14.** *MRI coronal. Detached membranes. Bile duct with membranes (white arrow).*

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*Surgical Treatment of Hepatic Hydatidosis DOI: http://dx.doi.org/10.5772/intechopen.86319*

Currently, diagnosis and follow-up of patients with cystic echinococcosis are achieved especially through imaging. Serology is used for the same purpose, using the detection of IgG-specific antigens. However, low sensitivity and specificity rates have been reported. In addition, false positives appear during follow-up due to the persistence of antibodies over time. There is a lot of research (recombined proteins, isotopic antibodies, subisotopic IgG, synthetic peptides), which seek to develop new antibodies by means of the molecular technique, allowing a better diagnosis of

Frequently, there are complications secondary to the hepatic location of the cyst or by involvement of adjacent organs, in which case symptoms and signs of greater

• More intense pain might appear when the Glisson capsule is stressed by larger cysts. In these cases, an abdominal mass mobilizing together with the respiratory movements is visualized during the physical examination. These giant cysts are easily visualized with the ultrasound. CT allows to define in more detail the elevated right hemidiaphragm and the development of secondary

• Another complication of large cysts occurs when there is an intrahepatic breach or rupture of the cyst to the peritoneum either spontaneously or by trauma. The discharge of fertile hydatid fluid in the liver or peritoneal cavity causes anaphylaxis of a different magnitude and new hydatid implants [43].

• Cyst rupture and emptying of hydatid fluid or membranes into the biliary tree lead to obstructive jaundice, many times accompanied by severe acute cholangitis [44, 45]. The cysts can become infected as well and determine the formation of liver abscesses, which can sometimes lead to septicemia. In these cases, CT and MRC allow to achieve a better definition of the characteristics of the abscess and whether there is emptying of hydatid material into the

• The chronic inflammatory process of hepatic cysts located in segments of the liver dome determines firm adhesions to the right hemidiaphragm and even transits toward the pleuropulmonary space. As a result of this transphrenic transit, patients may present pleural empyemas or bronchopneumonia [46]. CT and MRC help to achieve a better definition and provide the most appropri-

• There are occasions in which large cysts may be more complicated due to the simultaneous rupture and emptying of hydatid material to the biliary tree and bronchi. A bilio-pleuro-bronchial fistula is established with the occurrence of the pathognomonic sign of bilioptysis, i.e., the expectoration of the bile. These patients present a fairly severe septic episode with hepatic and respiratory functional compromise [47]. The thorax-abdominal CT and MRC are useful to

These complications are better visualized with the use of CT.

intensity will appear. Among them, the following should be mentioned:

**4.3 Serology**

this parasitosis [41, 42].

pulmonary basal atelectasis.

**5. Complications**

biliary tree.

ate and safe management.

diagnose this complication [39].

**Figure 15.** *MR cholangiography. Residual cyst membranes (white star). Cholangiohydatidosis.*
