Splenic hydatid infection is a rare form of hydatid disease, and isolated splenic involvement is even less common.
For a general discussion, and links to other system-specific manifestations, please refer to the article on hydatid disease.
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Epidemiology
Splenic hydatid disease has been reported to constitute up to 4% of cases of abdominal hydatid disease 4.
Clinical presentation
Splenic hydatid cysts are generally asymptomatic. When the cyst reaches an advanced size, the patient presents with a painful mass in the left hypochondrium 4.
Symptoms are nonspecific and include:
abdominal pain
enlarged spleen
fever
Pathology
Splenic hydatid cysts are usually solitary. As the hydatic cyst increases in size, it may lead to compression of the hilar vessels of the spleen, resulting in pericystic splenic atrophy. Eventually, the cyst may completely replace the splenic parenchyma. Chronic pericystic inflammation may cause adhesion with adjacent organs or even fistulization between the cyst and nearby organs such as the stomach, pancreas, left colon, left kidney or bronchus 2.
Aetiology
systemic dissemination
intraperitoneal spread from a ruptured hepatic hydatid cyst 1
retrograde spread from the liver to the spleen via the hepatic portal and splenic veins in portal hypertension 2
Radiographic features
Imaging findings are similar to those of hepatic hydatid disease and range from purely cystic lesions to a completely solid appearance 1.
Ultrasonography and CT are the most valuable imaging techniques for the diagnosis and evaluation of focal splenic diseases 3.
Treatment and prognosis
Management options include surgery but owing to the risk of spontaneous or traumatic rupture, splenic hydatid cysts are usually treated surgically with a total or partial splenectomy. Albendazole therapy is the mainstay of treatment in the postoperative follow-up period 4.
Complications
secondary infection is rare and usually occurs by haematogenous spread 2
cyst rupture
anaphylactic shock 3
Differential diagnosis
The differential diagnosis for splenic hydatid cysts includes other splenic cystic lesions:
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