THE ROLE OF COMPUTERIZED TOMOGRAPHY IN THE DIAGNOSIS OF HYDATID DISEASE

ABSTRACT

The main methods of diagnosis of echinococcus are overview radiography of the chest and abdominal cavity and ultrasound examination. However, multispiral computed tomography is a reliable method of confirming the diagnosis of echinococcosis, as well as an important diagnostic method for the differential diagnosis of nonparasitic cysts.  The article analyzes the results of the medical history of n= 34 patients with echinococcosis of various localization aged from 18 to 99 years.

АННОТАЦИЯ

Основными методами диагностики эхинококка являются обзорная рентгенография грудной клетки и брюшной полости и ультразвуковое исследование. Однако мультиспиральная компьютерная томография является надежным методом подтверждения диагноза эхинококкоза, а также важным диагностическим методом для дифференциальной диагностики непаразитарных кист.  В статье анализируются результаты анамнеза n= 34 пациентов с эхинококкозом различной локализации в возрасте от 18 до 99 лет.

Keywords: еchinococcus, computed tomography, radiology, parasitic diseases.

Ключевые слова: эхинококк, компьютерная томография, радиология, паразитарные заболевания

Introduction. Echinococcosis (alveolar and hydatid) is a natural focal disease, is one of the most dangerous zooanthropohelminthiasis and continues to be a serious medical and social problem worldwide, as it affects all age groups of the population and mainly people of working age [1]. Echinococcal disease is characterized by a long chronic course, severe organ and systemic disorders, extensive lesions that lead to disability and often to the death of the patient, as well as the difficulty of diagnosis and surgical treatment. The disease affects almost all organs and systems of the body [1, 2].

The most common localization of the parasite is the liver (50-80%) and lungs (6-40%), other forms of damage that belong to rare localities of the parasite (15-25%). The combined lesion of echinococcosis of the lungs and liver, according to a number of authors, ranges from 10 to 18% and from 9.8 to 14.8% [3].

Numerous complications (suppuration, bleeding, perforation, mechanical jaundice, portal hypertension, etc.) are observed in 23-63% of patients [4]. An important condition for the timely diagnosis of EG is the rational consistent application of a complex of clinical, laboratory and instrumental methods. Instrumental methods of examination are the main ones. A special place in the diagnosis of echinococcal liver cysts belongs to ultrasound, which has been widely used due to the absence of radiation exposure and high information content reaching 94% [5]. In the dynamics of the development of the disease, the assessment of complaints and anamnesis is of particular importance. The correct interpretation of the results of laboratory and instrumental examination methods allows not only to make the correct diagnosis in a timely manner, but also to identify asymptomatically developing complications [6].        

Arm: evaluation of the role and analysis of CT results in patients with echinococcal cysts

Materials and methods:  In the research work, the analysis of the medical history of n=34 patients aged 18 to 99 years was carried out. All patients underwent treatment and surgery at the A.N. Syzganov National Scientific Surgical Center, Almaty. Of these, women - n = 11, men - n= 23. The average age was 39.48±8.52 years.

During the diagnosis of the disease, a CT study of the frequency, density, and complications of the location of the echinococcal cyst was performed. The radiation dose is 25-140 kW. The density parameters were estimated in Hounsfield units in increments from 1.5 to 5 mm.

Additional ultrasound, X-rays, and biochemical blood parameters of all patients were also analyzed. Special attention was paid to bilirubin, ALT, AST creatinine, urea, amylase and total protein levels.

Statistical methods were used that made it possible to verify the analyzed data, the accuracy of the differences between the average values (М±m), the arithmetic mean values were evaluated by the T – criterion of Studenten. the difference at the level of р˂0,05 was considered statistically reliable. Statistical edits were collected in the electronic application Microsoft Office Excel.

Results. In n=5 (14.7%) patients, an asymptomatic course of the disease was revealed. The majority complained of pain – 76.47%, discomfort in the chest and upper abdomen – 64.7%, weakness – 38.23%, decreased appetite - 44.11%, skin rash, itching – 8.82%.

The patients had complications such as mechanical jaundice - 8.82%, spontaneous pneumothorax - 2.94%, pulmonary empyema - 2.94%, biliary fistula - 5.88%.

Serological methods and the EІA test were used to diagnose echinococcosis in our patients.  This helps in the differential diagnosis between echinococcosis and non-parasitic cysts [2].

In the study of CT parameters of patients, the average size of cysts is the average value 78,42±8,58, 67,51±3,67, 53,48±2,8 made mm. On average, the Hausfield scale was 18.62±3.61 HU (Figure 1).

Figure 1.CT result of patients with Echinococcosis of the lungs

In CT, in all n=31 cases, the insides of the formations had a liquid density (from +19.5 to +56.7H) and were in close contact with the surrounding tissues. Echinococcal cysts in all cases were oval in shape, in n=7 (20.58%) the contours were blurred due to peripocal inflammation, and in n=11 (32.35%) the contours were uneven. n=3 (11.76%) of calcination on the periphery, n=9 (26.47%) of calcination was multi – chamber (Figure 2).

Figure 2. CT results of patients with Echinococcosis of the liver

Figure 3. Lung echinococcosis complicated by spontaneous pneumothorax

Discussion. In our study, computed tomography (CT) was performed in all patients of the main group. CT has a sensitivity of 95-97% to liver echinococcosis [5]. With its help, it is possible to assess the level of calcification of the cyst wall, cystic structures, complications, determine operational tactics, and identify other information [6, 7].

The main indicators of its implementation: - with the difficulties of topographic diagnostics;

- clarification of topographic and anatomical relations for solving tactical tasks:

- selection of access and determination of the nature of damage;

- used when necessary for differential diagnosis of subcapsular cysts of the right part of the liver, extra-organic growths, echinococcal cysts of the right kidney or retroperitoneal fibers [8, 9]. The results of CT diagnostics in our work showed the absence of significant deviations during the operation.

Conclusion: CT is a fairly informative method that allows you to identify the general and specific signs of various cystic formations, make a differential diagnosis between parasitic and simple liver cysts.

References:

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