Fall 2012 - 08.pdf 718 | 1Medical Laser Application Research Center; Depart- ment of Urology, Shohada- e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Department of Radiol- ogy, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sci- ences, Tehran, Iran Mohammad Reza Razzaghi,1 Mohammad Mohsen Mazloomfard,1 Hooman Bahrami-Motlagh,2 Babak Javanmard1 Isolated Renal Hydatid Cyst Diagnosis and Management Corresponding Author: Mohammad Mohsen Mazloomfard, MD Medical Laser Application Research Center; Depart- ment of Urology, Shohada- e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Tel: +98 21 2271 8001 Fax: +98 21 8852 6901 E-mail: mazloomfard@ yahoo.com Received November 2010 Accepted March 2011 CASE REPORT Keywords: hydatid disease, Echinococcosis, kidney neoplasms, cysts INTRODUCTION H ydatid cyst involving the urinary tract is relatively uncommon.(1,2) The cyst growing in the kidney is slow and usually asymptomatic lasting for 5 to 10 years.(1) This disease is endemic in parts of the Middle East, South America, Australia, New Zealand, and Alaska.(3) of fullness in the abdomen. Successful treatment was accomplished with a kidney-sparing pericys- tectomy. CASE REPORT abdomen. The patient’s medical history was unremarkable. He was living in an urban area and working as a shopkeeper. Laboratory tests revealed eosinophilia, an erythrocyte sedimentation rate urinalysis. Chest radiography was unremarkable. Ultrasonography of the right kidney depicted renal enlargement and contour deformity due to a multi-loculated cystic lesion with an echogenic center measuring 4 cm in diameter (Figure 1). Thin septum was found in some cysts. Intravenous pyelography showed mass effects on the right kidney. Computed tomography (CT) scan revealed the presence of a multicystic lesion with thick and thin internal septations. No cystic or solid lesions were found in the liver, spleen, and left kidney. Case Report 719Vol. 9 | No. 4 | Fall 2012 |U R O LO G Y J O U R N A L Isolated Renal Hydatid Cyst | Razzaghi et al agglutination were performed, which had positive results. The patient was candidate for surgery. Kidney-sparing peri- cystectomy was performed, and the cyst was removed. The surgical specimen was occupied with considerable numbers of daughter cysts (Figure 3). The postoperative period was uneventful, and the patient was prescribed albendazole 400 mg twice daily for 4 weeks to prevent metastatic cyst formation. Pathologically, a multi- locular hydatid cyst with invaginated scolices in the cystic specimen was reported. The patient’s follow-up with ab- dominopelvic CT scan and chest radiography was normal in period of 2 years. DISCUSSION areas. Imaging studies are suggestive, but usually inconclu- sive, especially in a complicated cyst that mimics renal tumor or ureteropelvic junction obstruction appearance.(1,4,5) Intra- venous urography may demonstrate pyelocaliceal dilatation (6) Ultrasonography has been used to demonstrate multicystic or multiloculated masses. Advanced radiologic techniques, such as CT and magnetic resonance imaging, play an important role in the diagnosis. (6,7) a multiloculated cystic mass with heterogeneous density and daughter cysts.(8) renal hydatid disease. In 20% to 50% of cases, moderate eo- Figure 1. Longitudinal ultrasonography demonstrates a multi- cystic lesion in the upper pole of the right kidney. Calipers indi- cate approximate size of the lesion. Figure 2. Computed tomography after intravenous bolus of con- trast medium showing a multicystic lesion in the upper pole of the right kidney. Mass does not show contrast enhancement of the wall. Rosette structural pattern with presence of peripheral daughter cyst is seen with fluid density lower than that of paren- tal matrix. Figure 3. Surgical specimen exhibited multiple daughter cysts. 720 | sinophilia is present.(4) The Casoni and Weinberg tests have (9) Serologic and hemagglutination tests have low reliability, immunoelectrophoresis against arch-5.(10) In general, surgery is the best treatment for renal hydatid cyst, and if it is possible, kidney-sparing protocol is the logical op- tion, but nephrectomy must be reserved for non-functioning kidneys.(1,6) CONFLICT OF INTEREST None declared. Case Report REFERENCES 1. Angulo JC, Sanchez-Chapado M, Diego A, Escribano J, Tamayo JC, Martin L. Renal echinococcosis: clinical study of 34 cases. J Urol. 1997;157:787-94. 2. Kirkland K. Urological aspects of hydatid disease. Br J Urol. 1966;38:241-54. 3. Vuitton DA. The WHO Informal Working Group on Echino- coccosis. Coordinating Board of the WHO-IWGE. Parassito- logia. 1997;39:349-53. 4. Sayilir K, Iskender G, Ogan C, Arik AI, Pak I. A case of isolated renal hydatid disease. Int J Infect Dis. 2009;13:110-2. 5. 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