Hydatid cysts were well-known in antiquity and were described in various manuscripts such as the Hippocratic Corpus, the texts of Celsus, of Aretaeus, and of Galen. All ancient authors state that the illness usually occurs in the liver, while there are some cases where the affected organs are the brain, the lungs, and the spleen.
The hydatid cysts of the spleen present, nowadays, mostly as incidental finding in radiologic examination, as painless mass of the left upper quadrant or with atypical symptoms (such as a dull pain, weight in the hypochondrium, etc.). Rarely acute conditions, for example, acute abdomen or rupture into the bronchus constitute the initial presentation of the disease.[1]
The differential diagnosis includes all cystic lesions of the spleen. When the presentation of the disease is typical, the imaging characteristics of the cystic lesions are more than adequate to pose the diagnosis.[2] In rare cases, which the diagnosis is ambiguous, a combination of imaging and immunological examinations resolves the eventual nuances.
Regarding treatment, medical, interventional, and surgical options are available in the physicians’ arsenal. Current anthelminthic medications are not expected to exterminate the parasites; however, complementary therapy (prior or after surgery) is very often obligatory.[3] Concerning the interventional approaches, guided percutaneous drainage – either with echography or computed tomography – should be reserved for patients with high anesthesiologic risk or unwilling to undergo operation. Finally, the surgical approach currently remains the golden standard in treating hydatid cysts of the spleen. Surgery can be performed with the traditional open approach, laparoscopy, or robotic. Most of the cases require spleenectomy, however, the last years spleen-preserving operations are gaining their way.[4]
Rasheed et al.[5] sums up meticulously most of the knowledge concerning every facet of splenic hydatidosis, giving a global vision of the various aspects encountered from diagnosis to treatment.
Footnotes
Source of Support: Nil.
Conflict of Interest: None declared.
References
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