Alveolar echinococcosis-spreading disease challenging clinicians: A case report and literature review

作     者：Georgi Atanasov Christoph Benckert Armin Thelen Dennis Tappe Matthias Frosch Dieter Teichmann Thomas FE Barth Christian Wittekind Stefan Schubert Sven Jonas 

作者机构：Department of Visceral Transplantation Thoracic and Vascular Surgery Universitaetsklinik Leipzig Institute of Hygiene and Microbiology University of Würzburg Department of Infectious Diseases and Tropical Medicine Community Hospital Dresden-Neustadt Department of Pathology Universitaetsklinikum Ulm Institute of Pathology Universit tsklinikum Leipzig Department of Gastroenterology and Rheumatology Universitaetsklinik Leipzig 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2013年第19卷第26期

页      面：4257-4261页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Alveolar echinococcosis Echinococcus multilocularis Autochthonous infection Liver resection Hemihepatectomy 

摘      要：Human alveolar echinococcosis (AE) is a potentially deadly disease; recent studies have shown that the endemic area of Echinococcus multilocularis , its causative agent, is larger than previously known. This disease has low prevalence and remains underreported in Europe. Emerging clinical data show that diagnostic difficulties are still common. We report on a 76-year old patient suffering from AE lesions restricted to the left lobe of the liver who underwent a curative extended left hemihepatectomy. Prior to the resection a liver biopsy under the suspicion of an atypical malignancy was performed. After the intervention he developed a pseudoaneurysm of the hepatic artery that was successfully coiled. Surprisingly, during surgery, the macroscopic appearance of the tumour revealed a growth pattern that was rather typical for cystic echinococcosis (CE), i.e. , a gross tumour composed of multiple large vesicles with several centimeters in diameter. In addition, there were neither extensive adhesions nor infiltrations of the neighboring pancreas and diaphragm as was expected from previous imaging results. The unexpected diagnosis of AE was confirmed by definite histopathology, specific polymerase chain reaction and serology results. This is a rare case of unusual macroscopic presentation of AE that posed immense diagnostic challenges and had an eventful course. To our knowledge this is the first case of an autochthonous infection in this particular geographic area of Germany, the federal state of Saxony. This report may provide new hints for an expanding area of risk for AE and emphasizes the risk of complications in the scope of diagnostic procedures and the limitations of modern radiological imaging.