ISSN: 1899-0967
Polish Journal of Radiology
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2018
vol. 83
 
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Letter to the Editor

Intrabiliary ruptured cyst hydatid

Beuy Joob, Viroj Wiwanitkit

© Pol J Radiol 2018; 83: e333
Online publish date: 2018/07/02
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Dear Editor, the publication on “Intrabiliary Ruptured Cyst Hyda­tid” is very interesting. In this case, Mermi et al. mentioned that “In geographical areas endemic for hydatid disease, cyst rapture into the bile ducts should be included in the differential diagnosis even in seronegative cases, although it is not typical for hydatid cyst to be found as a mass lesion in the liver on US in patients with right upper quadrant pain and jaundice. Detailed imaging by MRI/MRCP should be done” [1]. There are some points for discussion. First, the main question is whether the diagnostic imaging is sufficient for diagnosis of hydatid cyst. In fact, the parasitic cystic lesion at liver and biliary tract is not uncommon, but the hydatid cyst usually presents a classical big cystic lesion [2]. The main differential diagnosis, for tropical countries, is cysticercosis [2]. Second, a possible answer to the question of why there is a seronegative result in the present case might be due to the basic clinical pathology principle, namely the prozone effect [3,4]. In immunodiagnosis or serodiagnosis, if there are excessive antigens, the false negative can be derived, and this might be the explanation for the present case. The way to resolve the problem and confirm diagnosis by serological test is by pre-analytical specimen dilution before repeated serological examination.

Conflict of interest

The authors declare no conflict of interest.

References

1. Mermi EU, Fidan N, Murat M. Focal Biliary System Obstruction and Atypical Liver Mass: Intrabiliary Ruptured Cyst Hydatid Case Report. Pol J Radiol 2017; 82: 110-113.
2. Brunetti E, White AC Jr. Cestode infestations: hydatid disease and cysticercosis. Infect Dis Clin North Am 2012; 26: 421-435.
3. Jacobs JF, van der Molen RG, Bossuyt X, Damoiseaux J. Antigen excess in modern immunoassays: to anticipate on the unexpected. Autoimmun Rev 2015; 14: 160-167.
4. Itoh Y, Yamaguchi T. Factors that affect analytical results in an enzyme immunoassay. Nihon Rinsho 1995; 53: 2143-2148.
Copyright: © Polish Medical Society of Radiology This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0). License allowing third parties to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
 
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