Case 2 by 李君思远

Briefly A 49 year-old woman presented with high fever and chills, jaundice, and upper abdominal pain for 3 days.

The patient was a recent immigrant from Argentina. One year before, she frist noticed a sensation of fullness in the right upper quadrant of her abdomen. Her past medical history was unremarkable. In her country of origin, she had been health and active, working in the field and breeding and raising sheepdogs.

Physical Examination VS: T 39.5 C, P112/min, R 18/min, BP102/60 mmHg PE: The patient appeared acutely ill and was obviously jaundiced. Right upper quadrant abdominal tenderness was noted.

Laboratory Studies WBC 22400/μl, Differential 55% PMNs, 20%bands, 12% lymphs, 8% eosinophils Serum chemistries: alkaline phosphatase 340 U/L bilirubin 4.3  mol/L

Imagine A CT scan of the liver demonstrated a large multiloculated cyst with bile duct dilation.

Primary Diagnosis

Review the Case History The patient was a recent immigrant from Argentina. One year before, she frist noticed a sensation of fullness in the right upper quadrant of her abdomen. Her past medical history was unremarkable. In her country of origin, she had been health and active, working in the field and breeding and raising sheepdogs.

Life cycle

Echinococcus granulosus

Hydatid

Microscopy protoscolex

Clinical Features Long incubation period Hepatic involvement Pulmonary involvement Brain involvement Rupture of the cysts

Clinical Diagnosis Case history is necessary Including occupation, native place, etc A tender mass in abdomen is of great help to diagnosis Imaging techniques:X-ray, CT, MRI,etc

Lab Diagnosis etiologic tests are often helpless serologic tests are ways of auxiliary diagnosis fine needle biopsy may be useful,but beware the leakage of hydatid fluid or protoscolices

Treatment Surgery(most common) Medication(after surgery)

Dilemma Why not diagnose the disease as an…

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