Recurrent liver hydatid disease: when does it become symptomatic and how does one diagnose it? Hiizir Yakup Akyıldız a, ⁎ , Alper Akcan a , İbrahim Karahan b , Can Kucuk a , Erdogan Sözüer a , Hüseyin Esin a a Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey b Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey Received 1 February 2008; accepted 10 May 2008 Abstract Background: Echinococcosis is a zoonotic disease that mainly occurs in sheep-grazing areas. Recurrence of the disease and its diagnosis are relatively new areas of investigation due to the limited number of cases. The aim of this study was to evaluate the diagnosis of the symptomatic recurrent liver hydatid disease and the efficacy of abdominal ultrasonography (US). Materials and Methods: Between 1988 and 2006, 412 patients with hydatid cyst of the liver were operated at Erciyes University Medical Faculty. We have considered a growing cyst at the original operative site or at the neighboring hepatic tissue as recurrence and investigated 38 of them for the recurrence of the disease (9.2%). Results: The recurrence usually occurred after 2 years. The majority of the cases were Types 2 and 3 (24 cases; 8 were Type 4 and 6 were Type 1) according to Gharbi classification. In 35 patients with recurrent disease approved after surgical exploration, US was successful in preoperative diagnosis (100%). Overall, the recurrence was demonstrated correctly by means of US in 35 patients (92.1%), and 23 of 26 patients (88.4%) were correctly diagnosed with the use of computed tomography. In our study, in the first 2 years after the operation, the success rate of US examination was 72.7%. The success rate of US rose up to 100% when the frequency of recurrence is highest. Conclusion: Beyond 2 years after surgery, US examination alone might be enough for the diagnosis of symptomatic recurrent liver hydatid disease in patients with the suspicion of recurrence. Postoperative early US profile and annual US examination must be performed for at least 5 years to prevent misinterpretation in doubtful cases. © 2009 Elsevier Inc. All rights reserved. Keywords: Liver hydatid disease; Recurrence; Abdominal ultrasonography; Surgery; Bilioma 1. Introduction Hydatid disease has been known since the time of Hippocrates, who described it as a ‘liver full of water.’ Echinococcosis is a zoonotic disease that mainly occurs in sheep-grazing areas. This relatively benign parasitic disease is characterized by slowly growing cysts. Developing countries with poor hygiene and where sheep and cattle are raised are high-risk areas for acquiring cystic echinococcosis [1]. With immigration, the prevalence of the disease has increased in Europe and North America [2–5]. Hydatidosis is caused by infection with larva of the tapeworms of the genus Echinococcus. Humans contract the infection from canines and feco-orally via infected eggs. Approximately 70% of hydatid cysts are located in the liver, and one quarter to one third of the cases have multiple cysts. The right lobe is affected in 85% of patients. Cysts are usually superficial and are composed of a two-layer laminated wall, an inner germinative membrane, and an outer adventitia [6]. The clinical features depend upon the site, size, stage of cyst and development, and viability of the cyst contents [7]. The disease may be asymptomatic for many years and may become symptomatic due to the mass effect of the enlarging Clinical Imaging 33 (2009) 55 – 58 ⁎ Corresponding author. Department of General Surgery, Erciyes University School of Medicine, Melikgazi 38039, Kayseri, Turkey. Tel.: +90 5334613605; fax: +90 3524374912. E-mail address: hyakyildiz@gmail.com (H.Y. Akyıldız). 0899-7071/09/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.clinimag.2008.05.003