Role of interventional radiology in the management of hepatic hydatid disease

Abstract

Hydatid disease, caused by the larval stage of Echinococcus granulosus, is a significant public health problem in endemic regions and worldwide. The liver is the most frequently affected organ, followed by the lungs, in adults. Hepatic hydatid cysts (HHC) may remain asymptomatic for years and are often incidentally detected on imaging. Radiological evaluation plays a pivotal role in the diagnosis and classification of hydatid cysts into World Health Organization types (cystic lesion and cystic echinococcus 1 through cystic echinococcus 5). Further, imaging also helps plan appropriate management and assists in image-guided percutaneous interventions when appropriate. Treatment strategies for HHC include anthelmintic therapy, surgery, percutaneous interventions, and a “watch and wait” approach. With advances in interventional radiology, minimally invasive percutaneous techniques have emerged as effective and safer alternatives to surgery in select cases. Procedures such as puncture, aspiration, injection, and re-aspiration, standard catheterization technique, modified catheterization technique, percutaneous evacuation, and Örmeci technique have demonstrated high cure rates, with reduced morbidity and mortality. Surgical management remains reserved for cysts that are ruptured or show communication with biliary ducts, and for cysts located in challenging anatomical locations. This review discusses the role of interventional radiology in HHC, highlighting the indications, techniques, and recent advancements in percutaneous management strategies.

Keywords: Hepatic hydatid cyst; Cystic echinococcosis; Puncture, aspiration, injection, and re-aspiration; Modified catheterization technique; Standard catheterization technique; Percutaneous evacuation; Scolicidal agent; Scolex viability test; Cysto-biliary communication; Cysto-biliary fistula

Core Tip: The various interventional radiology treatment options for hepatic hydatid cyst include puncture, aspiration, injection, and re-aspiration, standard catheterization technique, modified catheterization technique, percutaneous evacuation, and Örmeci technique. These interventions offer several advantages over traditional open surgery, including shorter hospital stays, lower complication rates, and shorter recovery times. Puncture, aspiration, injection, and re-aspiration and standard catheterization are primarily indicated for cystic echinococcus 1 (CE1) and CE3a cysts. Modified catheterization technique and percutaneous evacuation are primarily indicated for CE2 and CE3b cysts.