Intrabiliary rupture of hepatic hydatid cyst

Case contributed by Dr Kenan Cetinoglu

Presentation

Patient presented to the ER with jaundice and RUQ tenderness. History of PAIR and biliary catheterization for hepatic hydatid cyst.

Patient Data

Age: 70 years
Gender: Female

Abdominal US examination shows cystic lesion with internal echoes in right posterior segments of liver. Direct visualisation of cystobiliary communication and cystic material within adjacent dilated intrahepatic biliary duct.  Also similar cystic material in slightly thick-walled common bile duct was seen (cholangitis?).  Echogenic material in anterior branch of right portal vein suggesting thrombosis. Periportal fusiform shaped reactive lymph nodes were noted.

CECT abdomen shows a slightly distorted shaped cystic lesion in segment 7 with irregular wall and peripheral enhancement. Interruption of the anterior cyst wall  adjacent to a bile duct suggests cystobiliary communication. Coronal images nicely demonstrate the fistulous tract between the cyst to the right subphrenic space suggesting intraperitoneal rupture. Dilatation intra-extrahepatic biliary ducts and a biliary catheter extending from the left bile ducts to the common bile duct were noted. There are intraluminal filling defects and peripheral hypodensities, reflective of thrombophlebitis in right anterior segment of portal vein. 

Case Discussion

Rupture of a hydatid cyst into the biliary tract is a common complication of hepatic hydatid cyst infection. This may cause cholangitis, obstructive jaundice and even life threating sepsis.

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Case information

rID: 56634
Case created: 13th Nov 2017
Last edited: 18th Nov 2017
Inclusion in quiz mode: Included

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