TRIVIAL UPPER ABDOMINAL SYMPTOMS MASKING A LIFE-THREATENING HEPATIC ECHINOCOCCAL CYST

A 17-year-old girl from Turkey had for 6 years been suffering from rig ht-sided upper abdominal symptoms not usually related to food intake. Treatment of suspected gastritis remained ineffective. Laboratory test s were unremarkable, except for an accelerated erythrocyte sedimentati on rate (12/30 mm), eosinophilia (6.4 %) and albumin concentration of 52.6 g/l. Upper abdominal sonography revealed a cyst, about 10 cm in d iameter, in the right liver lobe. Computed tomography showed the 8 x 8 .5 cm cyst which was septated at its caudal portion and com pressed th e vena cava for 5.6 cm. The antibody titre against echinococcus antige n was 1:3200. At laparotomy the echinococcal cyst was found to have ex tended to the left adrenal gland, renal fat capsule and left part of t he diaphragm. There was a pressure necrosis on the right lateral aspec t of the vena cava. The affected parts were resected and the patient q uickly recovered. Postoperative treatment consisted of the administrat ion of mebendazole (1.5 g daily) for 18 months. - The patient had come from an area where echinococcal infection is endemic. The disease cou ld have been quickly and easily diagnosed and cured if sonography had been undertaken early, sparing the patient major surgery.