Percutaneous treatment of heterogenous predominantly solid echopattern echinococcal cysts of the liver

Purpose: We report our technique for and results of percutaneous treatment of heterogenous, predominantly solid echopattern hepatic hydatid cysts (HHC), i.e., complex type IV cysts according to Gharbi's sonographic classification of HHC. Methods: Eight patients with nine complex type IV HHC were treated by percutaneous aspiration followed by hypertonic saline ablation, using a 14 Fr van Sonnenberg sump drainage catheter under sonographic and fluoroscopic guidance. Results: Successful drainage of cysts contents was achieved in all eight patients. No major complications, such as anaphylaxis, abdominal dissemination, cyst recurrence, car death, occurred. Minor complications including pain (n = 4), mild fever (n = 5), right reactive pleural effusion (n 4), and transient hypernatremia (n = 2) were observed and managed conservatively. Follow-up imaging studies for an average period of 15 months (range 1-48 months) showed either complete healing (n = 3) or significant reduction in the size of the cyst with solidification (n = 6). Conclusion: Nine complex type IV HHC were effectively treated by suction of the membranes and hypertonic saline ablation using a 14 Fr sump drainage catheter, without major complications.