Hydatid liver disease: problems in diagnosis in the Middle East endemic area

Imaging techniques such as ultrasound (US), liver scan and computerized tomography (CT) localize mass lesions in the liver and abdomen, and are valuable tools in the differential diagnosis of hydatid disease. However, we present two cases from Kuwait in the Middle East which demonstrate that these techniques alone are not as accurate as claimed in this geographical area. A sensitive and specific serological test is essential for a pre-operative diagnosis of hydatid disease. Discrepancies between radiological imaging and serological diagnosis are best resolved by cytology of the drained fluid and/or histopathological examination of the excised cyst. Negative serology would indicate ultrasound-guided aspiration of cyst fluid for cytological verification or enzyme immunoassay.