Pediatrics case presentation in hydatid cyst

1. DR Zaira Hussain
FCPS II RESIDENT

2.  Fever -1 month
 Abdominal pain - 20 days.

3.  HISTORY OF
PRESENTING
COMPLAINTS

4.  PAST HISTORY: Multiple visits to nearby clinics due to same complaints.
 BIRTH HISTORY: Unremarkable.
 NUTRIONAL HISTORY: Consumes 3 meals a day,approximately 1300-
1500kcal/day.
 VACCINATION HISTORY: vaccinated according to EPI Schedule.
 DEVELOPMENTAL HISTORY: School going child with good academic score.
 FAMILY HISTORY: 3rd product of consanguineous marriage,all sibling are
normal and alive
 PERSONAL: Decreased appetite with good sleep and normal bowel habits.
 SOCIOECONOMICS: Living in rented house Using boring water, Father is
shopkeeper,no any pet history.

5.  Active alert male child sitting on bed with,canula on left hand
with following vitals:
-HR= 90bpm
-RR= 32bpm
-TEMPERATURE= Afebrile
-BP= 90/60(50th centile)
 A- C- CY-D- L- J- E-

6.  WEIGHT= 30KG(-2.00Sds)
 HEIGHT=140cm(-2.02Sds)

7.  INSPECTION:
There are no scar mark, striae, visible veins or pulsation.
 PALPATION:
Soft non tender on superficial palpation ,but on deep palpation mild
tenderness in right upper quadrant.
Liver was palpable 2cmbelow right costal margin, left lobe not palpable,soft
in consistency with clear margins, total liver span 12cm.
A well circumscribed mass palpable in epigastrium with smooth surface,
regular margins and hard consistency measuring 2*2cm
 PERCUSSION:
Fluid thrill and shifting dullness –ve
 AUSCULTATION:
Gut sounds audible.

8.  INSPECTION: No precordial
buldge,pulsation or scar mark.
 PALPATION: Apex beat palpated
at 5ICS medial to mid clavicular
line.
 AUSCULTATION: S1+S2+No
added sound
 INSPECTION:Bilateral equal chest
movement with respiration,no
deformity seen
 PALPATION:Trachea centrally
placed,chest expansion normal
 PERCUSSION:Normal
 AUSCULTATION:Bilateral equal
air entry with normal vesicular
breathing.

9.  Unremarkable

10.  ENTERIC WITH COMPLICATION
 LIVER ABSCESS
 HYDATID CYST
 LYMPHOMA/LEUKEMIA

16.  SLIGHT HEPATOMEGALY
WITH MILD
PARENCHYMAL
CHANGES.
 MULTIPLE CYSTIC
MASSES IN THE LIVER
AND SPLEEN.
 NORMAL GALL
BLADDER,PANCREAS
AND BOTH KIDNEYS.
 MULTIPLE CYSTIC
MASSES PRESENT IN
THE LOWER
ABDOMEN AND LEFT
LUMBAR REGION

20.  MultIple cystic areas of varying
sizes noted, involving liver and
spleen and also with in
peritoneum,showing internal
septations,some of them showing
peripheral daughter cysts.
 One of the splenic cyst measuring
upto 8.0*6.6cm and the hepatic
cyst is in segment VI which is
measuring upto 4.9*4.1cm.
 One of the peritoneal cyst
measuring 4.8*3.7cm.
 Lumbar muscular spasm noted.
 IMPRESSION:Findings represents
diffuse multiple hydatid cyst
involving liver,spleen and
peritoneum.correlate with
echinococcal titer

22. CYSTIC ECHINOCOCOSIS/
HYDATIDOSIS

23.  Treat medically for 3 months than follow patient in surgical
OPD.

24.  Admitted in UNIT-1
 Maintained IV Line
 Off oxygen/orally allowed
 Injection 0.9% D/w started.
 Risek sachet 20mg (1*OD half an hour before breakfast)
 Tab Albendazole 15mg/kg divided 12 hourly, with
meal.

25.  Tab Albendazole 15mg/kg divided 12 hourly for three weeks
with gap of one week.
 for nine consective weeks with gap of one week after each
three week duration.
 Follow up in surgery OPD after three months.

27.  the hydatic disease, caused by the larvae of
Echinococcus granulosus, is a zoonotic disease
potentially lethal, which can be found anywhere
in the world, but especially in endemic areas.
The hydatic cyst is mainly found in the liver
(75% of the cases), being asymptomatic in most
cases and discovered accidentally on a routine
abdominal ultrasound or an ultrasound
performed for diagnosing other pathologies.

34.  Routine blood investigation are non specific-25%
(Esinophilia abd raised bilirubin)
 Indirect hemagglutination tesr and ELISA are the most widely
used methods for detection of anti-Echinococcus IgG
antibodies

35.  Chest Xray
 Ultraound abdomen
 CT-Scan
 MRI

41.  MEDICAL;
For cystic echinococcosis(CE) type 1 or 3a that are <5cm in
diameter,albendazole chemostherapy alone(15mg/kg/day)
orally divided twicw daily for 1-6 months maximamum
800mg/day may result in high rate of cure.

44.  Factors predictive of success with chemotherapy are age of
cyst(>2years),low internal complexity of the cyst,and small
size and site of the cyst is not important,although cyst in
bone respond poorly.for alveolar hydatidosis,if surgical
removal is unsuccessful,the average mortality is 92% by 10
years after diagnosis.

45.  Important measures ti interrupt transmission include
aa,through handwashi,avoiding contact with dogs in endemic
areas,boiling orr filtering water when camping,and proper
disposal of animal carcasses.
 Other useful measures are control or treatment of feral dog
population and regular praziquantel treatment of pets and
working dogs in endemic areas.
 Vaccibes have been developed to prevent infection in grazing
animals but are not widely used.