The initial stage of alveolar echinococcosis is a diagnostic challenge: a case report
Abstract
Alveolar echinococcosis is a rare, potentially fatal parasitosis with the main manifestation site in the liver. Diagnosis already in the initial stage of the disease is important to prevent further exacerbation and possible secondary complications by early targeted therapy. Identifying alveolar echinococcosis lesions on imaging can be difficult, and making the diagnosis can be an interdisciplinary challenge, even in a specialized center. In a clinically symptom-free 65-year-old white female patient with type 2 diabetes mellitus, an abdominal ultrasonography performed by a colleague in private practice revealed three small hepatic nodules as incidental findings. Further workup focused primarily on the differential diagnosis of hepatic metastatic malignancy. Therefore, a sonographically guided biopsy of the liver lesions was performed under inpatient conditions. During the control sonography routinely performed after the biopsy to exclude postinterventional hemorrhage, an examiner previously uninvolved in the case noticed the typical sonomorphology of initial alveolar echinococcosis lesions in view of the biopsied nodules. The specimens that had been collected peripherally from the target lesion under the primary assumption of metastases histopathologically showed no signs of malignancy and no other landmark findings. Follow-up staining of the biopsies with regard to the recently suspected diagnosis of alveolar echinococcosis, however, remained without a target result as well.…
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