**3.2 Gharbi classification in USG**

Type 1: Pure liquid collection. Type 2: The decomposition of the germinative membrane and the pericyst. Type 3: Multivesicular type. Type 4: Heterogeneous echo pattern. Type 5: The calcified wall.

### **3.3 2001 WHO classification**

	- Unilocular anechoic cystic lesion [2]
	- No any internal echoes or septations
	- Uniformly anechoic cyst with fine internal echoes, may only be visible after patient repositioning (**Figure 1**).
	- Internal echoes represent "hydatid sand" (fluid and protoscolices originating from a ruptured vesicle).
	- Cyst with internal septation (**Figure 2**)
	- Septa represent walls of daughter cyst(s)
	- Described as multivesicular, rosette, or honeycomb appearance
	- Evolving appearance of daughter cyst(s) within the encompassing parent cyst
	- **3A**—daughter cysts have detached laminated membranes (water lily sign) (**Figure 3**)
	- **3B**—daughter cysts within a solid matrix

**Figure 1.** *CE1 hydatid cyst in both liver lobes shown in abdominal CT scan [3].*

**103**

*The Surgical Management of Hydatid Cyst of the Liver: What is New?*

*CE3a hydatid cyst in right liver lobe shown in abdominal CT scan [3].*

*DOI: http://dx.doi.org/10.5772/intechopen.90726*

• **CE 4** (inactive/degenerative)

• **CE 5** (inactive/degenerative)

wool sign)

**Figure 3.**

**Figure 4.**

**4. The medical treatment**

○ Absence of daughter cysts (**Figure 4**)

*CE4 hydatid cyst in right liver lobe shown in abdominal CT scan [3].*

○ Arch-like, thick partially or completely calcified wall

The goal of the treatment is mainly to stop the growth of the cyst and to eliminate the risk of infection or rupture. Unless the cysts are small, cyst hydatid disease is treated surgically because of high risk of secondary infection and rupture. Benzimidazole-derived antibiotics such as mebendazole and its new analogue albendazole are used. Medical treatment with albendazole relies on drug diffusion along the cyst membrane. The concentration of drug obtained in the cyst is

○ Mixed hypoechoic and hyperechoic matrix, resembling a ball of wool (ball of

**Figure 2.** *CE2 hydatid cyst in right liver lobe shown in abdominal CT scan [3].*

*The Surgical Management of Hydatid Cyst of the Liver: What is New? DOI: http://dx.doi.org/10.5772/intechopen.90726*

#### **Figure 3.**

*Overview on Echinococcosis*

• **CE 1** (active stage)

• **CE 2** (active stage)

• **CE 3** (transitional stage)

(**Figure 3**)

patient repositioning (**Figure 1**).

○ Cyst with internal septation (**Figure 2**)

○ Septa represent walls of daughter cyst(s)

○ **3B**—daughter cysts within a solid matrix

*CE1 hydatid cyst in both liver lobes shown in abdominal CT scan [3].*

*CE2 hydatid cyst in right liver lobe shown in abdominal CT scan [3].*

from a ruptured vesicle).

○ Uniformly anechoic cyst with fine internal echoes, may only be visible after

○ Internal echoes represent "hydatid sand" (fluid and protoscolices originating

○ Evolving appearance of daughter cyst(s) within the encompassing parent cyst

○ **3A**—daughter cysts have detached laminated membranes (water lily sign)

○ Described as multivesicular, rosette, or honeycomb appearance

**102**

**Figure 2.**

**Figure 1.**

*CE3a hydatid cyst in right liver lobe shown in abdominal CT scan [3].*

#### **Figure 4.** *CE4 hydatid cyst in right liver lobe shown in abdominal CT scan [3].*

	- Absence of daughter cysts (**Figure 4**)
	- Mixed hypoechoic and hyperechoic matrix, resembling a ball of wool (ball of wool sign)
	- Arch-like, thick partially or completely calcified wall
