Echinococcosis differential diagnosis: Difference between revisions
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==Differential Diagnosis== | |||
Echinococcal cyst must be differentiated from: | |||
<small> | |||
{| class="wikitable" | |||
! rowspan="3" |Disease | |||
! rowspan="3" |Causes | |||
! colspan="11" |symptoms | |||
! rowspan="3" |Lab Findings | |||
! rowspan="3" |Imaging Findings | |||
! rowspan="3" |Other Findings | |||
|- | |||
! rowspan="2" | Fever | |||
! colspan="2" | Pain | |||
! rowspan="2" | cough | |||
! rowspan="2" | Hepatomegaly | |||
! rowspan="2" | Jaundice | |||
! rowspan="2" | Weight loss | |||
! rowspan="2" | Anorexia | |||
! rowspan="2" | Diarrhoea | |||
or Dysentry | |||
! rowspan="2" | Nausea and | |||
vomiting | |||
! rowspan="2" | Stool | |||
|- | |||
! Abdominal pain | |||
(right upper quadrant pain) | |||
! Pleuritic pain | |||
|- | |||
|[[Amoebic liver abscess]] | |||
|[[Entamoeba histolytica]] | |||
|✔✔✔ | |||
|✔✔✔ | |||
|✔/✘ | |||
|✔ | |||
|✔✔/✘ | |||
|✔ | |||
(late stages) | |||
|✔ | |||
(late stages) | |||
|✔ | |||
|✔ | |||
|✔ | |||
| | |||
|[[Hypoalbuminemia]] | |||
(✔) | |||
| | |||
* [[Ultrasound]] is the gold standard technique for diagnosing [[amoebic liver abscess]] | |||
| | |||
* Respond well to [[chemotherapy]] and rarely require drainage | |||
* Marked male predominance | |||
* More common in developing countries | |||
* [[Sero-positive]] | |||
* Right lobe is more frequently involved | |||
|- | |||
|[[Pyogenic liver abscess]] | |||
|Bacteria | |||
* [[Gram-positive]] [[aerobes]] | |||
* [[Gram-negative]] enterics | |||
* [[Anaerobic]] organisms | |||
* [[Acid fast bacilli]] | |||
|✔ | |||
|✔ | |||
|✔✔ | |||
|✔✔ | |||
|✔/✘ | |||
|✔✔✔ | |||
|✔ | |||
(acute loss) | |||
|✔ | |||
| | |||
|✔ | |||
|Pale/dark | |||
|[[Hypoalbuminemia]] | |||
(✔✔✔) | |||
|Cluster sign | |||
* [[CT scan]] shows cluster sign | |||
* Aggregation of multiple low attenuation [[liver]] lesions in a localized area to form a solitary larger [[abscess]] cavity | |||
| | |||
* Abnormal pulmonary findings | |||
* [[Diabetes mellitus]] increases the risk | |||
* Medical-surgical approach is indicated | |||
* More common in developed countries | |||
* Culture positive and [[sero-negative]] | |||
* Both lobes are commonly involved | |||
|- | |||
|Fungal liver abscess | |||
|''[[Candida|Candida species]]''<br>[[Aspergillus|Aspergillus species]] | |||
|✔ | |||
|✔ | |||
|✔/✘ | |||
|✔ | |||
|✔ | |||
|✔ | |||
|✔ | |||
|✔ | |||
|✔ | |||
|✔ | |||
| | |||
| | |||
|CT and Us findings with four patterns of presentation: | |||
* Wheel-within-a-wheel pattern | |||
* Bull’s-eye configuration pattern | |||
* Uniformly hypoechoic nodule | |||
* Echogenic foci with variable degrees of posterior acoustic shadowing | |||
| | |||
* Less common | |||
* Pure fungal abscess or associated with [[pyogenic abscess]] | |||
* [[Candida]] and [[Aspergillus]] are commonly found in the culture of aspirated pus | |||
* Associated with underlying [[malignancy]] or [[DM]] | |||
|- | |||
|[[hydatid cyst|Echinococcal (hydatid) cyst]] | |||
|[[Echinococcus granulosus]] | |||
| | |||
|✔ | |||
| | |||
|✔ | |||
| | |||
|✔ | |||
([[Obstructive jaundice]]) | |||
|✔ | |||
|✔ | |||
| | |||
| | |||
| | |||
|Histology: [[Hydatid cyst]] with three layers | |||
a.The outer pericyst, which corresponds with compressed and fibrosed [[liver]] tissue | |||
b.The endocyst, an inner germinal layer | |||
c.The ectocyst, a thin, translucent interleaved membrane | |||
|Ultrasound: | |||
* Cystic to solid-appearing pseudotumors | |||
* Water lily sign | |||
* [[Calcifications]] seen peripherally | |||
| | |||
* Blood or liquid from the ruptured cyst may be coughed up | |||
* [[Pruritis]] | |||
|- | |||
|Malignancy | |||
(Hepatocellular carcinoma/Metastasis) | |||
| | |||
*[[Hepatitis B]] and [[hapatitis C|C]] | |||
*[[Aflatoxins]] | |||
*[[Alcohol]] | |||
*[[Hemochromatosis]] | |||
*[[Alpha 1 antitrypsin deficiency]] | |||
*[[Non alcoholic fatty liver disease]] | |||
|✔ | |||
|✔ | |||
(uncommon) | |||
| | |||
| | |||
|✔ | |||
|✔ | |||
|✔✔ | |||
| | |||
| | |||
|✔✔ | |||
|Pale/Chalky | |||
| | |||
* High levels of [[alpha-fetoprotein|AFP]] in serum | |||
* Abnormal [[liver function test]]s | |||
| | |||
* [[Liver biopsy]] | |||
|Other symptoms: | |||
* [[Splenomegaly]] | |||
* [[Variceal bleeding]] | |||
* [[Ascites]] | |||
* [[Spider nevi]] | |||
* [[Asterixis]] | |||
|} | |||
</small> | |||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} |
Revision as of 18:35, 8 March 2017
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Differential Diagnosis
Echinococcal cyst must be differentiated from:
Disease | Causes | symptoms | Lab Findings | Imaging Findings | Other Findings | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fever | Pain | cough | Hepatomegaly | Jaundice | Weight loss | Anorexia | Diarrhoea
or Dysentry |
Nausea and
vomiting |
Stool | ||||||
Abdominal pain
(right upper quadrant pain) |
Pleuritic pain | ||||||||||||||
Amoebic liver abscess | Entamoeba histolytica | ✔✔✔ | ✔✔✔ | ✔/✘ | ✔ | ✔✔/✘ | ✔
(late stages) |
✔
(late stages) |
✔ | ✔ | ✔ | Hypoalbuminemia
(✔) |
|
| |
Pyogenic liver abscess | Bacteria
|
✔ | ✔ | ✔✔ | ✔✔ | ✔/✘ | ✔✔✔ | ✔
(acute loss) |
✔ | ✔ | Pale/dark | Hypoalbuminemia
(✔✔✔) |
Cluster sign |
| |
Fungal liver abscess | Candida species Aspergillus species |
✔ | ✔ | ✔/✘ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | CT and Us findings with four patterns of presentation:
|
| ||
Echinococcal (hydatid) cyst | Echinococcus granulosus | ✔ | ✔ | ✔ | ✔ | ✔ | Histology: Hydatid cyst with three layers
a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue b.The endocyst, an inner germinal layer c.The ectocyst, a thin, translucent interleaved membrane |
Ultrasound:
|
| ||||||
Malignancy
(Hepatocellular carcinoma/Metastasis) |
✔ | ✔
(uncommon) |
✔ | ✔ | ✔✔ | ✔✔ | Pale/Chalky |
|
Other symptoms: |