Classic and unusual appearances of hydatid disease in children

Abstract

Background. In endemic regions, hydatid disease is commoner in children than in adults. The hydatid cysts may have classic appearances, but unusual sites and appearances may cause diagnostic difficulties.

Objective. To assess the classic and unusual appearances of hydatid disease in children.

Materials and methods. A 3-year retrospective review of available imaging of proven hydatid disease at a tertiary paediatric institution.

Results. Review of imaging of 21 children (9 boys, 12 girls), with a mean age of 8 years and 1 month, demonstrated cysts in the liver (n=9), lung (n=8), brain (n=7), spleen (n=2), heart (n=1), orbit (n=1) and soft tissues (n=1). Multi-organ involvement occurred in eight cases with two cases that did not involve the liver. Complicated cysts were found in 13 cases and usually involved the liver (n=8) and lung (n=5). An unusual case of spontaneous cerebrospinal fluid (CSF) spread was also documented.

Conclusions. Hydatid disease in children classically involves the liver, lung and brain but can involve almost any organ and numerous organs simultaneously. Whether hydatid disease is discovered incidentally or by intentional imaging, extended imaging is recommended to identify multifocal disease which may also display complicated cysts that may assist in the diagnostic process. All patients with one known site should undergo a minimum of an abdominal US and CT scan of the chest and brain. CT may be used instead of US of the abdomen, and MRI may be used to replace CT of the brain. Over 50% of cases in our study showed complicated cysts. Unique findings of this study include multi-organ involvement without liver cysts. Multiplicity and complications of cysts can assist diagnosis. Intraventricular and intrathecal CSF spread of a spontaneously ruptured intracerebral cyst has not, to our knowledge, been previously reported.