Beruflich Dokumente
Kultur Dokumente
Imaging
Vincenzo Lorenzo Migaleddu1, E. Derchi3
Essay
Carlo Martinoli3,
of Renal
Maurizio
Hydatid
Cysts
Renata Senarega2, Fabio Pretolesi3,
H
nococcus
ydatid
dition
disease
caused
is a pathologic
by
con-
detect cific
antibody antigen
against from
Arc-S.
at times
confused
with
neoplastic
or A of
the cyst stage of by the tapeworm EchiThe adult form of the intestinal cattle,
where
isolated
unilocular
calcifications,
cyst fluid. However, intact duce a low level of antigenic up to 30% hydatids followed
rare (3%)
parasite nines,
of caare
cattle
of hepatic
lesions
of lung
the cyst gives rise to a lacy pattern. Complete calcification of the wall of an hydatid cyst can
The disease
sheep
is relatively
and
(59%),
and is
of
[1]. Involvement
eastern
Australia
and countries surrounding Sea [1]. Pathologically, containing with two germinative clear distinct fluid
layers:
hematogeneous spread, are commonly tary, and are located at the upper or lower
solipole
is a cavity by a wall
nucleated,
of the kidney. Clinically, renal lesions are usually asymptomatic; when present, symptoms are those of a space-occupying with palpable mass, pain,
Complications include infection renal lesion
membrane
and
hematuria.
cleated layer made of innumerable laminations. The host surrounds with nuclear
cysts,
in the
renal
sinus
cyst
a third
layer: fibroblasts,
Rupture passage
[3-5].
of the
sinus the
containing
and eosinophilic
becomes a thick
of hydatid
material
capsule
called
ganisms
a pericyst.
that grow
The
with
hydatids
slow
are living
progressive
oren-
Plain
Films of the renal shadow, usually finding visible on However, calcifiencountered plain Their films pattern in and about is not
largement with
within
changes, cysts
lesion.
Enlargement
development
at one pole, can be the only plain film of the abdomen. cations
have 20-30%
of the parasite
elicits
can
been
be
sensitivity,
reported of cases
hemoagglutination
specific, ranging from thin, eggshell-like involvement of the outer wall, to a dense, reticular appearance (Fig. 1). A crushed eggshell
with
immunoelectrophoresis
Fig. 1.-65-year-old man with large hydatid cyst of lower pole of right kidney causing medial displacement of ascending colon. Radiograph shows thin calcifications located within wall of daughter cysts, producing reticular appearance.
di Radiologia,
Universit#{224} Sassari, Viale San Pietro, iO, 07i00 Sassari, Italy. di Ospedale di Sestri Levante (GE), Via A. Terzi, 43/A, i6039 Sestri Levante (Genova), Italy. Universit#{224} Genova, Viale Benedetto di
036i-803X/97/i695-i339 American
2Servizio di Radiologia,
3 Istituto
di Radiologia,
correspondence
to LE. Derchi.
AJR i997;i69:i339-i342
AJR:169, November
1997
1339
Migaleddu
et aI.
system,
These
so that contrast
cysts usually
media
have a
because
contrast
rarely,
medium
contrast
among
larger
the daughter
lesion. More
medium content
can result.
flows
around
the tightly
wall, and appearance
cyst
sign be
a crescent
in
between
the
the
so-called
outer wall
pseudoclosed contrast
of
cyst in which
epithelium the collecting as irregular and
medium
the cyst
rupture
hydatid defects
can be seen
pelvis
ureter
that
may
cause
obstruction
[7, 8].
Sonography
The typical finding of a renal cyst with a
multiloculate Fig. 2.-6i-year-old woman with renal colic. A, Urogram reveals inferior displacement of upper calices ofleft kidney by mass with fewfaint calcifications (arrows). B, Contrast-enhanced CT scan shows heterogeneous cystic lesion on medial aspect of kidney. Internal calcifications are clearly visible. floating echoes
appearance,
and curvilinear
containing
internal
internal
septa, echoes scolices, is
observed
in most cases
are related to presence of hooklets, and brood capsules within the hydatid
so-called hydatid sand. Septa can
fluid,
be
the
be considered perhaps
an indication
or
displacement
of calices have
(Figs. 2A.
3A.
and
attrib-
4A).
They
no pathognomonic
features at
IV Urography Closed hydatids. without communication with the caliceal system. present as space-occupying masses that cause compression and
urography. and only detection of a thick, dense wall surrounding a heterogeneous center at nephrotomography area, the diagnosis have a communication can suggest, in an endemic of the disease. Open cysts
between the
uted to detached membranes, to the walls of the daughter cysts that develop within the larger one, or to both of these findings. However, the diagnosis of hydatid disease not always straightforward. early stages of development, on sonograms In fact, in hydatid cysts is
the
hydatid
can
A, Urogram
man with acute pancreatitis. reveals both compression and cranial displacement of inferior calices by large hydatid cyst. Cranially, note calcifications of walls of larger cyst, whereas caudaily, smaller daughter lesions are well delineated. B, Sagittal sonogram ofleft kidney (K) reveals highly reflective calcific surface of cyst (arrows) with posterior acoustic shadow. Calipers indicate approximate size oflesion (10 cm). C, CT scan shows enlargement of lower pole of left kidney caused by heterogeneous mass. Within lesion, note both irregular calcifications and cysts with peripheral calcification of outer walls. Fig. 3-30-year-old
1340
AJR:169,
November
1997
Fig. 4-33-year-old
man with
right
renal
pain.
A, Radiograph reveals large hydatid cyst on upper pole of right kidney, causing compression and displacement of upper calices. Thin calcifications are
appreciated on cranial contour (arrows). B, Sagittal sonogram shows solid hyperechogenic mass (arrowheads) with anechoic areas consistent with fluid at periphery. p = renal pelvis.
present even
thicker spective difficult
anechoic of parasitic
of simple of hydatid
lesions cysts
serous renal anechoic cysts. cyst
[91.
and
a pro-
cysts give
and to their
rise to two
number.
typical by
are slightly
may lesion be is
findings:
CT
findings
of
hydatid
renal
cysts
are
not
pathognomonic. renal
cysts tivity
As
and from
with
other
sonography. from
complicated
probcystic
renal
ternal
typical fluid
septa.
rosette within
produced
pattern daughter
walls,
to the fact lower
and
that density
such lesions
a completely
CT has lower
in revealing thin
sensisepta
detected.
Daughter
cysts
develop
at later stages
than
2B
that
and
of the parent
can 3C). The and be proper does not
lesion
easily wall
(Fig.
identified
7). Wall
(Figs.
and make the diagnosis easier. However. thin septa and calcitications of the wall can be encountered also in simple serous renal cysts.
whereas served and. a also rarely. multiloculate in multilocular cell can pattern cystic carcinomas. be suspected tests [3-6]. can be obnephromas A diagnoonly are in pos-
calcifications
or hydatid
sand
14-71.
Epidemiologic
criteria
enhance
The
increase after
finding
in denof
and laboratory tests are of basic importance and can help direct the diagnosis toward the presence of parasitic disease when imaging findings
cysts
lesion
are
nonspecific.
High-density
renal
in renal disease
in the literature
This
sis of hydatid
be related
have been related to the presence of complicated fluid within the lesion due to high protein content.
viscous ings can
endemic
itive cifications with some hydatid lesion lesion correct
areas
or when
laboratory
of infestation
as acoustic
Wall calareas
old hemorrhage.
In hydatid
or gelatinous
disease, such
or
find-
dur-
material. be related
hyperechogenic
to complete
filling
shadow
cysts. in completely material tumor
(Fig.
membranes. the and (Fig.
3B).
parent
In
and
cyst by hydatid sand or membranes. disease must be added to the possible tial diagnosis list of hyperdense setting [12]. where least in a clinical high prevalence
allows cystic
them
one
to
classify
hyperdense
lesions
and to avoid
(Figs.
misin-
as tumors
6B and 6C).
be suspected
ual cystic
mass.
spaces
can be recognized
(Fig.
within
4B).
the
usually
at the periphery
The sonographic
ulate collecting with direct hydatid renal systeni
appearance
cyst has that been
ruptured
communication pelvis
between
CT In CT studies.
sions with is
hydatid to presence
cysts
present
as pattern
le-
a heterogeneous
structural
that
related
of the
daughter
AJR:169,
November
1997
1341
Migaleddu
et al.
Fig.
6-53-year-old
man with
acute
pancreatitis.
A, Axial
of small hydatid cyst of right kidney (k) presenting contrast enhancement revealed lesion as small,
C, After contrast enhancement, MR Imaging MR accurately complex Five cases in a review imaging renal internal of renal has the
with solid appearance (arrowheads). highly attenuating mass of lateral aspect cyst appears hypodense to renal parenchyma (arrowhead).
of kidney
(arrowhead).
can
renal
show
hydatid useful
cysts sonography
as spaceand
East Norwalk.
masses.
lesions and to identify the structure of hydatid cysts. lesions have been reported imaging findings
[13].
CT
tients
are the
with
most renal
techniques both
in pawhen
ton & Lange, 1989:503-509 3. OLeary P. A five-year study disease in Turkana 1976;53:540-544 4. Gogus disease.
5.
of human East
echinococcosis,
district,
Kenya.
on the MR
evaluation of a suspected hydatid cyst is needed and when an occasional renal mass
is encountered during studies performed for
0, BrJ
Beduk Urol
Y, Topukcu 1991:68:466-469
Z. Renal
hydatid
patients with abdominal echinococcosis With the exception of wall calcifications, same diagnostic used with criteria of renal hydatid can be used for CT and sonography this MR imaging [13].
unrelated
sion with
reasons.
internal
Detection
septations
of a cystic
and sand or,
leat or
Aragona F, Di Candio G, Serretta V. Fiorentini L. Renal hydatid disease: report of 9 cases and discussion of urologic diagnostic procedures. Urol Parasitic disease of the urogAJR
in the
diagnosis
7. Beggs
of hydatid
plain
films
can
Surgery,
with
partial
or total
nephrectomy
1985;145:639-648
8. Gislanz V. Lozano cysts: communicating
AiR 1979:135:357-361
calcifications
of the
and
according to location and size of the lesion, is the treatment of choice for patients with renal hydatidosis hydatid cyst has [4].
been
hydatid system.
Although considered
puncture of a possible
9. Oner A. Demircin G, Akhan 0, Oner K. Renal hydatid cyst detected in a child during the course of acute postglomerulococcal Nephron 1995:69:193-194 glomerulonephritis.
source of anaphylactic reactions and spread of the parasite, percutaneous treatment of liver lesions under sonographic guidance has been reported to be a safe and effective procedure [ 14]. Sonography seems to be considered the best-suited therapy with needle
content
10. Badea R, Andreica M, Hutanu I, Miu N. Echinococcus cyst ruptured into the renal pelvis: ultrasound 293-296 1 1. Baltaxe HA, Fleming Ri. The angiographic appearance of hydatid disease. Radiology 1970;97: 599-604 12. Dunnick NR, Korobkin M, Silverman PM, Foster WL Jr. Computed tomography of high density renal
458-461
findings.
Eur
Ultrasound
1995:2:
procedure aspiration
injection of
followed saline
by
hypertonic location
also in patients
[9].
with
renal
of the disease
cysts.
Comput
Assist
Tomogr
1984;8: L, et al.
Imag-
13. Kalovidouris
A, Gouliamos
A, Vlachos disease.
Abdom
of lower pole of left kidney. Mass has contrast enhancement of wall and rosette structural pattern with presence of peripheral daughter cysts with fluid density lower than that of parent lesion.
I. Marsden PD. The cestodes. In Beeson PB. McDermott W, eds. Textbook of ,nedicine. Philadelphia: Saunders. 1975:510-511 2. Schantz Goldsmith
of abdominal hydatid i,Ig 1994:19:489-494 14. Filice C, Pirola F, Brunetti peutic approach for hydatic under and alcohol
Gastroentero!ogv
MRI
PM.
In:
inedi-
injection
R. Heyneman
1342
AJR:169,
November
1997