A giant splenic hydatid cyst: Why calcified cysts should not
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29 year old male suffering from chronic intermittent pain of the abdomen, especially in the left flunk and LUQ over the past 3 years, came to the hospital. In an exhaustive history taking, the patient had a dull background aching abdominal pain which has no clear relationship with eating and defecation. Despite any clear relationship between the pain and eating or defecation, he was treated with irritable bowel disease suspicion. Because of maintenance of the pain, while the patient represents a vague history of urinary tract symptoms such as dysuria or frequent urination before, with, or after the pain, he was referred to a urologist with suspicion of uroliths. No signs of nephrolithiasis were found in examination and kidney, ureter, and bladder X-ray. In the US imaging, kidneys were normal while enlarged pampiniform plexus veins in both scrotums (Grade II varicocele) found which seemed irrelevant to the pain.

Regarding the patient's complaint to the existence of chronic pain on the left side of the abdomen, the radiologist assessed the left upper abdominal quadrant despite the main physician's focus on urinary tract disorders. A calcified hyperco heterogeneous internal cyst was observed with an approximate size of 110 × 93 mm in the splenic parenchyma suitable with stage 5 of Garbi's classification of cysts 10 (Figure 1). The patient was subjected to contrast enhanced computerized tomography (CECT) scan. CT demonstrated relative splenomegaly and evidence of well-defined complex cystic lesion of the approximate size of 106 × 92 × 93 mm in the splenic parenchyma. The cyst margin was calcified while internal fluid with hyperdense membranes suggested the existence of a typical hydatid cyst (Figure 1). The involvement of other organs was not shown. The patient was subjected to surgical approach and given 10 mg/kg/day albendazole for 3 days preoperatively. The cyst was centrally located close to the hilum.

Total splenectomy performed because of the location and size of the cyst. Gross and histopathological examinations reported active “hydatid cyst” as shown in Figures 2A and 2B. Different layers of the cyst were observed in microscopic examination. No postoperative sepsis or infectious complications were seen. After splenectomy, the patient experienced 7 days of hospital stay and took 10 mg/kg/d albendazole for 21 days orally. The patient has been vaccinated preoperatively with a single dose of pneumococcal polyvalent vaccine. He was followed up every 3 months for 1 year, and ultrasound imaging was performed every 6 months to evaluate the probability of recurrence. No postoperative recurrence was recognized in the periodic follow up.