Role of interventional radiology in the management of hepatic hydatid disease

Hydatid disease, caused by the larval stage of Echinococcus granulosus, is a significant public health problem in endemic regions and worldwide. The liver is the most frequently affected organ, followed by the lungs, in adults. Hepatic hydatid cysts (HHC) may remain asymptomatic for years and are often incidentally detected on imaging. Radiological evaluation plays a pivotal role in the diagnosis and classification of hydatid cysts into World Health Organization types (cystic lesion and cystic echinococcus 1 through cystic echinococcus 5). Further, imaging also helps plan appropriate management and assists in image-guided percutaneous interventions when appropriate. Treatment strategies for HHC include anthelmintic therapy, surgery, percutaneous interventions, and a "watch and wait" approach. With advances in interventional radiology, minimally invasive percutaneous techniques have emerged as effective and safer alternatives to surgery in select cases. Procedures such as puncture, aspiration, injection, and re-aspiration, standard catheterization technique, modified catheterization technique, percutaneous evacuation, and Örmeci technique have demonstrated high cure rates, with reduced morbidity and mortality. Surgical management remains reserved for cysts that are ruptured or show communication with biliary ducts, and for cysts located in challenging anatomical locations. This review discusses the role of interventional radiology in HHC, highlighting the indications, techniques, and recent advancements in percutaneous management strategies.