[Differential diagnosis of commonplace upper abdominal symptoms: hepatic echinococcosis]

A 17-year-old girl from Turkey had for 6 years been suffering from right-sided upper abdominal symptoms not usually related to food intake. Treatment of suspected gastritis remained ineffective. Laboratory tests were unremarkable, except for an accelerated erythrocyte sedimentation rate (12/30 mm), eosinophilia (6.4%) and albumin concentration of 52.6 g/l. Upper abdominal sonography revealed a cyst, about 10 cm in diameter, in the right liver lobe. Computed tomography showed the 8 x 8.5 cm cyst which was septated at its caudal portion and compressed the vena cava for 5.6 cm. The antibody titre against echinococcus antigen was 1:3200. At laparotomy the echinococcal cyst was found to have extended to the left adrenal gland, renal fat capsule and left part of the diaphragm. There was a pressure necrosis on the right lateral aspect of the vena cava. The affected parts were resected and the patient quickly recovered. Postoperative treatment consisted of the administration of mebendazole (1.5 g daily) for 18 months. The patient had come from an area where echinococcal infection is endemic. The disease could have been quickly and easily diagnosed and cured if sonography had been undertaken early, sparing the patient major surgery.