Is image guided PFA indicated for treatment of hydatid cyst disease

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 


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