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Hydatid disease is an endemic zoonosis, and patients are generally from cattle- and sheep-raising regions of the world, such as Central Europe, the Mediterranean, the Middle East, China, South America, Australia, New Zealand, South Africa, and Russia (Lewall and McCorkell in Radiology 155:773-775, 1985). Furthermore, hydatid cyst is a disease of immigrants in non-endemic countries and in developed countries (Stojkovic et al. in PLoS Negl Trop Dis 6:e1880, 2012). The most common affected organs are liver and lungs. Hydatid cyst located in the subcutaneous tissue constitutes an extremely rare manifestation of the hydatid disease (Savulescu et al. in Chir Buchar Rom 1990 105:419-422, 2010). In this study, we report an uncommon case of hydatid cyst that developed in the subcutaneous tissue of the right thigh of a patient with ultrasound, computed tomography, and magnetic resonance imaging findings.
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AIM: To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease. METHODS: Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays. RESULTS: The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively). CONCLUSION: There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.
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OBJECTIVES: The purpose of this study was to determine the usefulness of ultrasound elastography in the evaluation of enlarged cervical lymph nodes in comparison with B-mode and color Doppler sonography. METHODS: A total of 220 lymph nodes in 168 consecutive patients who were referred for sonography of the neck were included in this study. B-mode sonograms were evaluated according to short-axis diameter, long-to-short-axis ratio, hilum, echogenicity, and microcalcification. For color Doppler sonography, 5 different patterns were defined according to vascularity. Elastographic patterns of the lesions were categorized to 5 main types. The mean strain index values were calculated for all lymph nodes. Histopathologic findings, clinical and laboratory data, and imaging findings were used as reference standards for the diagnosis of benign and malignant lymph nodes. RESULTS: Of the 220 lymph nodes, 69.5% were diagnosed as benign, and 30.5% were diagnosed as malignant. The sensitivity, specificity, and accuracy of B-mode sonography were 97.0%, 31.4%, and 51.3%, respectively; the values were 76.1%, 82.4%, and 80.5% for color Doppler sonography and 82.1%, 56.2%, and 64.1% for elastography. The strain index cutoff value for the differentiation of benign and malignant lymph nodes was accepted as 1.7. The sensitivity, specificity, and accuracy of the strain index were 71.6%, 76.5%, and 75.0%. CONCLUSIONS: Ultrasound elastography adds no additional value to combined B-mode and color Doppler sonography for differentiation of benign and malignant cervical lymph nodes.
