Is image guided PFA indicated for treatment of hydatid cyst disease?
- Cystic echinococcosis is caused by Echinococcus granulosus.
- Previously PFA/PCD of a suspected echinococcal cyst or hydatid cyst disease was an absolute contraindication because of fatal anaphylaxis from spillage of the scolices.
- However, published series describe favorable results with oral albendazole treatment combined with PCD or with the puncture, aspiration, injection, reaspiration (PAIR) technique.
- The cyst contents are aspirated via the percutaneous puncture.
- Contrast is injected under fluoroscopic guidance to ensure there is no communication with the bile ducts and then a protoscolicide such as hypertonic saline or ethanol is injected, allowed to sit, and then reaspirated.
- Modified PAIR uses placement of a catheter, which allows more complete evacuation of the endocyst and repeat injections of protosolicide, and is especially useful for treating large cysts.
- Oral albendazole treatment must be started at least 4 hours prior to percutaneous intervention.
- Caution: The risk of fatal anaphylaxis is not entirely eliminated and thus appropriate emergency medical treatment and resources must be readily available
