Case: 34 years old male who recently traveled to Middle East is admitted to ICU with abdominal pain and sepsis like picture. Workup led to the diagnosis of Echinococcosis. Ultrasound report reads "presence of daughter cysts." Why this information is important?
Answer: Ultrasound plays an integral role in the diagnosis of Echinococcus with a sensitivity of up to 95 percent. The reason for this importance is due to its ability to classify as active, transitional, or inactive cysts based on the biologic activity.
The two well-known classifications are the World Health Organization (WHO) and the Gharbi classification.
Documentation of daughter cysts seems vital for management plan. Daughter cysts imply cysts that have involuted from the wall and reside within the larger cyst. It is to be noted that daughter cysts almost always form in the liver, and rarely in the lungs, in case they get involved.
Rupture of cysts in peritoneum may cause anaphylaxis and can be fatal.
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References:
1. World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) standardized classification of Echinococcal cysts. PAIR: Puncture, Aspiration, Injection, Re-Aspiration: An option for the treatment of Cystic Echinococcosis. WHO/CDS/CSR/APH/2001.6. World Health Organization 2001.
2. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology 1981; 139:459.
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