This slides gives you the Facts & Salient features of Liver Cysts / Interesting Case Reports covering Main Departments of Clinical side with Recent Advances made in the treatment of Liver cyst & Key points.
2. “ Is Life worth living ?
It all depends on the Liver ! ”
- William James
(1842-1910 )
3. Contents of Discussion
Facts & Salient Features – Liver Cysts
My Personal Experience – Hydatid Cyst
Around Each Dept – Interesting case reports
Recent Advances
Key points
4. Salient Features
Anatomy – Segmental Anatomy
Common – Rt side – “stream-line”
Segment – VII - common
Hepatomegaly – Sign – U.problem
Cysts > 10cm – CB communication
Most series in the literature are relatively
small, reporting fewer than 50 patients each.
5. Couinaud Classification
•Divides the liver into 8 functionally independent segments.
•Each segment has its own vascular inflow, outflow and biliary drainage
22. Dermatology
ATT – Started
(a)
Post Att – Wt + But UC contd-
Rpt X-ray – No lesions
(b)
23. Dermatology
Further tracing - etiology – U/S abd
U/S – 55X52mm mature HC – Rt lobe
Ref – Gastro dept.
CT/HIAA – confirmed / Alb - started
PCA – after 1 wk – POP – discharged
7hr later – A/E – gen.pruritis / uc / ang face/
hands / dyspnoea / cyanosis
Emerg trt – Stabilised
Discharged
24. Late onset Anaphylaxis – HC case
with chronic urticaria
First manifestation – CSU - Endemic
CU - > 6 wks
Type I sens – urt. Symp.
PCA – Obs – 1 day
Etiol – CSU
Late – onset
28. Cardiac HD
III - world
*Cardiac Ecchinococcosis -
rare disease.
*Its incidence varies from
0.02-2%.
*Commonly seen in the left
ventricle arising from the
subepicardial region.
Asp.
/Cyst.pericystectomy
Thoracotomy -
recovered
29. Orthopedics
50 yr – pain & swelling – Lt – thigh
Needle biopsy – 6 yrs back
HPE – HC – Lt femur
Surg – adv – pt – refused / Trt – cons.
L/E Lge immobile / painless mass – AL surf
lt.thigh & limping with pain
Lab – WNL / U/S – abd & CT – thorax - N
Plain X-ray & MRI – HC
31. Orthopedics
Surg – Debridement
E-O portion of the cyst was dissected and excised
10 minutes after injection of 50 mL 10% povidone-iodine
solution into the cyst
Lt k.jt was opened .Intercondylar notch was drilled
upto distal femoral metaphysis. An 8 mm ET tube
was inserted into the intercondylar notch, and its
cuff has been inflated to prevent any leakage.
32. Orthopedics
P-iodine soln. was injected - intubation tube into
the medullary cavity. After 10 mts, all daughter
vesicles and germinative membranes aspirated
safely from the distal end through the intubation
tube, which has been placed previously, while
aspirating simultaneous drilling and broaching the
medullary cavity of the left femur from proximal to
distal was performed.
33. Orthopedics
Drains were removed - 3rd POD. HPE - was
reported as echinococcal hydatid cysts of femur.
Pt – discharged with crutches.
10 days - discharge, the patient came back with a
spontaneous pathological fracture of the left femur
Thorough debridement – done. NEO hydatid
disease was observed intraoperatively.
34. Orthopedics
The IMC was filled with vancomycin beads
& closed, and the patient was put into skeletal
traction from tuberosity of tibia.
When the infection has ceased, the pathological
fracture has been treated using a custom-made
interlocking intramedullary nail.
35. HD - Femur with an Extraosseous Extent
-pathological Fracture
Bone hydatidosis is about 1–2.5% of all human
hydatid disease
Spine is the most common location (50%)
D/D – Bone tumors & TB / Fungal
Bone hydatidosis - often asymptomatic & is
usually detected only after a pathologic fracture,
secondary infection, or neurovascular symptoms
caused by compression
36. HD - Femur with an Extraosseous Extent
-pathological Fracture
The forming defect after curettage or excision is
a major problem. The dead space can be filled
with bone grafts, bone cement, or
endoprostheses.
Bone grafts can be invaded by the parasites,
and recurrence is often common.
A stepped surgical care should be planned.
37. Paediatrics
6 yr boy – attended – AE
Prod.cough / dyspnoea
P/H – LOA & weakness
C/E - ↓ air entry Rt + wheeze
Trt – Bdtrs. – no response
Chest X-ray – cyst – middle lobe - Rt
CECT – “ Warerlilly sign ” + pleural eff.
Trt – Alb + Radical cystectomy
Fully recovered