Fact-sheet: Alveolar echinococcosis of liver - Echinococcus multilocularis
Updated on 05/13/2023 at 1:46 PM
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Definition
Only in the northern hemisphere.
In France: Eastern regions and the Massif Central.
Caused by the larva of Echinococcus Echinococcus.
Rare but severe: behaves like a malignant lesion with very slow progression.
Clinical features
Long asymptomatic (sometimes for several years)
Right hypochondrium pain and late jaundice.
Laboratory findings
Cholestasis, cytolysis, occasionally hepatocellular insufficiency.
Ultrasound
Solid, infiltrative lesion, with calcifications and no enhancement, associated with several small round cysts on all imaging modalities.
CT
CT shows an invasive, irregular hypodense lesion and is particularly useful for depicting calcifications.
MRI
Differentiates the 2 components of the lesion:
- Solid (necrosis, granuloma and fibrosis): T1 hyposignal with low contrast enhancement.
- Cystic (vesicles + liquefied necrosis): T2 hyperintensity.
Vascular, extrahepatic and biliary involvement (MR cholangiography).
Nuclear medicine
Hypermetabolic activity of type 1, 2 and 3 lesions (containing vesicles-microcysts)
Management
- Surgery: curative resection resembling oncologic surgery. Given the predominantly right-sided location: right hepatectomy is often performed. - Associated antiparasitic drug treatments. - Liver transplantation: in highly symptomatic forms (hilar invasion).
Classification
Kodama classification
-Type 1: Multiple small cysts without a solid component
-Type 2: Multiple small cysts with a solid component
-Type 3: Solid component with large irregular cysts
and multiple small cysts
-Type 4: Solid component without cysts
-Type 5: Large cysts without a solid component.