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September 30, 2024, 07:26

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First, I would like to congratulate the authors for their excellent work that reports precisely the role of ultrasonography as the first step in diagnosing liver echinococcus cyst. The paper is comprehensive and well-written, accompanied by many impressive imaging figures. Echinococcosis or hydatid disease is caused mainly by the dog tapeworm Echinococcus granulosus and occasionally by the fox tapeworm Echinococcus multilocularis (alveolaris). Infection by the former exhibits a rather chronic, benign course. Infection by the latter, seen in north and central Europe, Switzerland, Alaska, Canada, Russia, Japan, and China, resembles carcinoma and without treatment is ultimately fatal; there have been reports mistaking it for hepatic carcinoma. The hydatid disease predominantly affects the liver, and surgical management, despite its difficulties and high recurrence rates, is considered the cornerstone of treatment. The incidence of liver echinococcal cyst has considerably reduced across the world owing to concerted public health hygiene and sanitary measures to disrupt the parasite cycle between the main host (dog,wolf, fox) and the intermediate host (human, sheep, cow, pig), but it remains endemic in some areas.. Diagnosis is established by current imaging techniques (US, CT, MRI-MRCP), aided by serum serology tests for antibodies against hydatid antigens. Specific anti-echinococcal antibodies (IgG, IgM), detected by ELISA (with a sensitivity of 95–97%) is the most widely used serologic test in everyday practice. Modern MRI depicts accurately the details of a hepatic echinococcal cyst as well as the communication with the biliary tree. MRCP showing dilatation of the biliary tract and echinococcal material in it may be valuable. Surgery is the main treatment modality in the management of liver echinococcosis caused by echinococcus granulosus, especially in large solitary cysts. It includes the most demanding radical procedures (total pericystectomy or hepatectomy) and the more conservative procedures (cyst evacuation, partial cystectomy, and drainage or omentoplasty). Complete removal of the cyst ensures permanent cure and should be the treatment of first-choice. In contrast, liver echinococcosis caused by echinococcus multilocularis (alveolaris) is not usually amenable to surgical treatment, except in drug therapy by Albendazole. It is used at a dose of 10 mg/kg/day. One tablet of 400 mg twice daily is the usual therapeutic scheme. A cycle of 28 days is recommended, followed by a washout period of 14 days, and repetition again.

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