Keywords
hydatid - aorta - albendazole - MRI
A 36-year-old woman presented with history of dull aching pain in the abdomen, on
and off fever, and intermittent cough for 1 month. She had been operated for frontal
lobe hydatid cyst 6 months earlier. Her postoperative status was uneventful, and she
was maintained on albendazole therapy.
On physical examination, splenomegaly was found with weak femoral pulses. Her biochemical
and hematological findings were unremarkable except for elevated erythrocyte sedimentation
rate. Chest radiography and electrocardiogram were normal.
Biphasic computed tomography revealed multiple hydatid cysts, with the largest measuring
3 cm × 2.4 cm in the abdominal aorta. Volume rendered images ([Fig. 1A]) revealed complete occlusion of the infrarenal aorta with abrupt cut-off in its
infrarenal segment at the L2 level with partial reformation of distal bilateral common
iliac artery by multiple collaterals. Mesenteric collaterals, such as the marginal
artery of Drummond and the arc of Riolan were highly developed. Dilated, tortuous
intercostals, and internal mammary arteries were also seen. Sagittal magnetic resonance
imaging using True fast technology with steady state precession (TrueFISP) sequence
shows multiple hydatid cysts in the infrarenal aorta ([Fig 1B]).
Fig. 1 (A) CT scan demonstrating complete aortic occlusion (arrow) and highly developed collaterals
(via internal mammory and abdomen vessels), see text. (B) Hydatid cysts filling and occluding the infrarenal aorta. The largest one (2.4 cm × 3 cm)
is marked by the arrow.
Hydatid disease is a parasitic infestation caused by the larval stage of Echinococcus. Hydatid disease can infest any part of the body; however, arterial involvement is
rare.[1]
[2] Involvement of the abdominal aorta is usually due to embolization from cardiac hydatid
cysts or direct invasion and can be present at intravascular or intramural locations.[3]
Aortic hydatid disease can present with fatal complications, such as anaphylaxis,
pseudoaneurysm formation, systemic embolism, and arterial occlusion. Resection with
graft interposition has been described successfully in few case reports. Systemic
medical therapy with albendazole along with surgery can help in eradication and prevention
of recurrence.
