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Multitechnique Evaluation of Renal Hydatid Disease

Ahmet Tuncay Turgut¹, Kemal Ödev², Adnan Kabaaliolu³, Shweta Bhatt⁴ and Vikram S. Dogra⁴

¹ Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey.
² Department of Radiology, Meram Faculty of Medicine, Selçuk University, Konya, Turkey.
³ Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
⁴ Department of Imaging Sciences, University of Rochester School of Medicine, 601 Elmwood Ave., Box 648, Rochester, NY 14642.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —56-year-old man with surgically proven renal hydatid disease. Excretory urography image reveals curvilinear wall calcification (arrowhead) of hydatid cyst located at upper pole of left kidney and causing slight caliceal distortion (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —56-year-old man with surgically proven renal hydatid disease. Axial contrast-enhanced CT scans at nephrographic (B) and pyelographic (C) phases show enhancement and calcification of cyst wall (dashed arrow, B; dashed arrow, C).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —56-year-old man with surgically proven renal hydatid disease. Axial contrast-enhanced CT scans at nephrographic (B) and pyelographic (C) phases show enhancement and calcification of cyst wall (dashed arrow, B; dashed arrow, C).

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —40-year-old woman with serologically proven renal hydatid disease. Sonogram shows renal hydatid cyst with floating parasitic membranes (arrow) after percutaneous treatment.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —40-year-old woman with serologically proven renal hydatid disease. Axial CT scan shows unilocular left renal hydatid cyst with thick wall (solid arrow) and slightly heterogeneous internal density because of infolded parasitic membrane (dashed arrow).

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —14-year-old girl with serologically proven renal hydatid disease showing solidification of internal echotexture of hydatid cyst. Sonogram reveals daughter cyst (calipers) within renal hydatid cyst with indistinct margins and mixed internal echogenicity (arrow). LK indicates left kidney.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —14-year-old girl with serologically proven renal hydatid disease showing solidification of internal echotexture of hydatid cyst. Pretreatment T2-weighted MR image shows well-circumscribed hyperintense cyst with internal isointense daughter cysts (arrow).

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —14-year-old girl with serologically proven renal hydatid disease showing solidification of internal echotexture of hydatid cyst. Sagittal sonogram of right kidney obtained 1 year after percutaneous treatment shows solidification of internal echotexture of hydatid cyst (circumscribed lesion).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —52-year-old woman with surgically proven left renal hydatid cyst. Axial contrast-enhanced CT scan shows multiloculated left renal hydatid cyst with mixed density (arrow).

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —52-year-old woman with surgically proven left renal hydatid cyst. Axial T2-weighted MR image reveals rim sign (arrow) with low signal intensity corresponding to wall of left renal hydatid cyst as well as daughter cysts (asterisk) appearing hyperintense relative to maternal matrix.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —63-year-old man with serologically proven disseminated hydatid disease. Sagittal sonogram shows type I renal hydatid cyst (arrow) with well-defined, purely anechoic internal echotexture.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —63-year-old man with serologically proven disseminated hydatid disease. Contrast-enhanced axial CT scan reveals involvement of liver (solid arrow), spleen (dashed arrow), and right kidney (open arrow) by hydatid disease.

View larger version (184K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —68-year-old woman with surgically proven renal hydatid disease. Coronal T1-weighted (A) and T2-weighted (B) MR images show decreased (arrow, A) and increased (arrow, B) signal intensities, representing pure cystic character for hydatid cyst located at upper pole of left kidney.

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —68-year-old woman with surgically proven renal hydatid disease. Coronal T1-weighted (A) and T2-weighted (B) MR images show decreased (arrow, A) and increased (arrow, B) signal intensities, representing pure cystic character for hydatid cyst located at upper pole of left kidney.

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —54-year-old man with surgically proven renal hydatid disease. Coronal T1-weighted (A) and T2-weighted (B) MR images show decreased signal intensity (solid arrow, A) and mixed internal signal intensity (solid arrow, B) within hydatid cyst located at upper pole of left kidney. Nodular liver lesion (open arrows, A and B) that appears as heterogenously hypointense in A and hypointense with peripheral and internal signal void areas in B corresponds to hydatid cyst with internal and wall calcifications.

View larger version (174K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —54-year-old man with surgically proven renal hydatid disease. Coronal T1-weighted (A) and T2-weighted (B) MR images show decreased signal intensity (solid arrow, A) and mixed internal signal intensity (solid arrow, B) within hydatid cyst located at upper pole of left kidney. Nodular liver lesion (open arrows, A and B) that appears as heterogenously hypointense in A and hypointense with peripheral and internal signal void areas in B corresponds to hydatid cyst with internal and wall calcifications.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —50-year-old man with surgically proven right renal hydatid cyst. Axial T2-weighted MR image shows infolded hypointense linear structures within right renal hydatid cyst (arrow), corresponding to collapsed parasitic membranes.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —50-year-old man with surgically proven right renal hydatid cyst. Gadolinium-enhanced MR image shows enhancement of collapsed internal membranes and cyst wall (arrow).

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —17-year-old girl with serologically proven renal hydatid disease. Serial sonograms obtained during (A and B) and then 1 week (C), 2 years (D), and 3 years (E and F) after percutaneous treatment of left renal hydatid cyst reveal reduction in size and volume of cyst, irregularity of cyst walls, and solidification of cyst contents with changes in echo pattern, which are signs of cure. A and B show sonographic guidance for puncture of cyst with 18-gauge Chiba needle (arrow, A) and administration of absolute alcohol (95%) to cavity through needle (arrow, B) for scolicidal effect and sclerosis. Hydatid cyst (double arrows, C) shows mixed echogenicity because of collapsed membranes. Pseudotumor appearance (arrow, D) is present because of disappearance of fluid component. Sagittal (double arrows, E) and axial (arrow, F) sonograms of treated cyst show irregular, hypoechoic, solid structure. LK indicates left kidney.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —17-year-old girl with serologically proven renal hydatid disease. Serial sonograms obtained during (A and B) and then 1 week (C), 2 years (D), and 3 years (E and F) after percutaneous treatment of left renal hydatid cyst reveal reduction in size and volume of cyst, irregularity of cyst walls, and solidification of cyst contents with changes in echo pattern, which are signs of cure. A and B show sonographic guidance for puncture of cyst with 18-gauge Chiba needle (arrow, A) and administration of absolute alcohol (95%) to cavity through needle (arrow, B) for scolicidal effect and sclerosis. Hydatid cyst (double arrows, C) shows mixed echogenicity because of collapsed membranes. Pseudotumor appearance (arrow, D) is present because of disappearance of fluid component. Sagittal (double arrows, E) and axial (arrow, F) sonograms of treated cyst show irregular, hypoechoic, solid structure. LK indicates left kidney.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —17-year-old girl with serologically proven renal hydatid disease. Serial sonograms obtained during (A and B) and then 1 week (C), 2 years (D), and 3 years (E and F) after percutaneous treatment of left renal hydatid cyst reveal reduction in size and volume of cyst, irregularity of cyst walls, and solidification of cyst contents with changes in echo pattern, which are signs of cure. A and B show sonographic guidance for puncture of cyst with 18-gauge Chiba needle (arrow, A) and administration of absolute alcohol (95%) to cavity through needle (arrow, B) for scolicidal effect and sclerosis. Hydatid cyst (double arrows, C) shows mixed echogenicity because of collapsed membranes. Pseudotumor appearance (arrow, D) is present because of disappearance of fluid component. Sagittal (double arrows, E) and axial (arrow, F) sonograms of treated cyst show irregular, hypoechoic, solid structure. LK indicates left kidney.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9D —17-year-old girl with serologically proven renal hydatid disease. Serial sonograms obtained during (A and B) and then 1 week (C), 2 years (D), and 3 years (E and F) after percutaneous treatment of left renal hydatid cyst reveal reduction in size and volume of cyst, irregularity of cyst walls, and solidification of cyst contents with changes in echo pattern, which are signs of cure. A and B show sonographic guidance for puncture of cyst with 18-gauge Chiba needle (arrow, A) and administration of absolute alcohol (95%) to cavity through needle (arrow, B) for scolicidal effect and sclerosis. Hydatid cyst (double arrows, C) shows mixed echogenicity because of collapsed membranes. Pseudotumor appearance (arrow, D) is present because of disappearance of fluid component. Sagittal (double arrows, E) and axial (arrow, F) sonograms of treated cyst show irregular, hypoechoic, solid structure. LK indicates left kidney.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9E —17-year-old girl with serologically proven renal hydatid disease. Serial sonograms obtained during (A and B) and then 1 week (C), 2 years (D), and 3 years (E and F) after percutaneous treatment of left renal hydatid cyst reveal reduction in size and volume of cyst, irregularity of cyst walls, and solidification of cyst contents with changes in echo pattern, which are signs of cure. A and B show sonographic guidance for puncture of cyst with 18-gauge Chiba needle (arrow, A) and administration of absolute alcohol (95%) to cavity through needle (arrow, B) for scolicidal effect and sclerosis. Hydatid cyst (double arrows, C) shows mixed echogenicity because of collapsed membranes. Pseudotumor appearance (arrow, D) is present because of disappearance of fluid component. Sagittal (double arrows, E) and axial (arrow, F) sonograms of treated cyst show irregular, hypoechoic, solid structure. LK indicates left kidney.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9F —17-year-old girl with serologically proven renal hydatid disease. Serial sonograms obtained during (A and B) and then 1 week (C), 2 years (D), and 3 years (E and F) after percutaneous treatment of left renal hydatid cyst reveal reduction in size and volume of cyst, irregularity of cyst walls, and solidification of cyst contents with changes in echo pattern, which are signs of cure. A and B show sonographic guidance for puncture of cyst with 18-gauge Chiba needle (arrow, A) and administration of absolute alcohol (95%) to cavity through needle (arrow, B) for scolicidal effect and sclerosis. Hydatid cyst (double arrows, C) shows mixed echogenicity because of collapsed membranes. Pseudotumor appearance (arrow, D) is present because of disappearance of fluid component. Sagittal (double arrows, E) and axial (arrow, F) sonograms of treated cyst show irregular, hypoechoic, solid structure. LK indicates left kidney.

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