PMC3354352_01
Preprocedure volume rendered CT scan reconstructions show multiple multivesiculated, honeycomb-like, hydatid cysts (type CE2) at the level of the VIII-VII and IV liver segments (A) and within the V-VI liver segments (B)
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F1
CT scan confirmed the presence of multiple hydatid multivesiculated (honeycomb-like) cysts (type CE2), almost totally replacing the right liver parenchyma [Figure 1].
Under fluoroscopic guidance, a 10 Fr pigtail drainage catheter (Flexima  multipurpose, Boston Scientific, Natick, MA, USA) was placed within the cyst in the VIII liver segment. After contrast injection, no communication with the bile ducts is detected
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F2
Due to the large dimensions of the cyst (maximum diameter of 12 cm), under fluoroscopic guidance, a 10 Fr pigtail drainage catheter (Flexima  multipurpose, Boston Scientific, Natick, MA, USA) was positioned within the cyst at the level of the VIII liver segment [Figure 2].
After placement of the two basket-type catheters (OptiMed, Ettlingen, Germany) within the cysts of the IV, V, and VI liver segments, anteroposterior (A) and lateral views (B) after contrast injection show communication of the cysts with the right biliary ducts, with visualization of the common bile duct
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F3
After drainage catheter placement, cavitography in multiple projections revealed communication with the bile ducts [Figure 3] and therefore alcohol was not injected but the catheters were left in place in order to resolve the biliary fistula and collections.
After 6 months, fluoroscopy after iodinated contrast injection shows complete healing of the cysts and no communication with the biliary tree (A). Volume-rendered CT scan image (B) confirms the satisfactory result with a small residual collection within the right liver (arrow)
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F4
After 3 months, the biliary communication resolved, with healing of the cysts; both the drainage catheters were subsequently removed [Figure 4A]. A CT scan confirmed the satisfactory final result [Figure 4B].
Follow-up abdominal USG shows calcification within the VI- VII liver segment (arrowhead), without any evidence of a hydatid cyst
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F5
USG examination done 18 months later showed no recurrence of the liver hydatidosis [Figure 5].