Cystic Echinococcus of the Liver.

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Cystic echinococcosis is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm, which is transmitted by dogs and found on every continent except Antarctica. We sought to review the life cycle, epidemiology, symptoms, diagnostic methods, and treatment of Echinococcus granulosus of the liver. A comprehensive review was conducted using Medline/PubMed, Google Scholar, Cochrane Library, and the Web of Science accessed between 1990 and 2024. The main search focused on "Cystic Echinococcus of the Liver." The following terms were used: cystic echinococcosis, hydatidosis, echinococcus granulosus, echinococcus life cycle, liver cyst, albendazole, liver resection, pericystectomy, cysto-biliary fistula, and percutaneous aspiration injection and reaspiration (PAIR). EC should be considered in the differential diagnosis of hepatic cysts, especially among individuals with risk factors, such as individuals who have traveled to or immigrated from areas with a high prevalence. Echinococcus species require two hosts to complete their life cycle, with humans acting as intermediate hosts that become infected by ingesting eggs from contaminated environments, leading to cyst formation, typically in the liver or lungs. Symptoms are based on cyst size and location, such as abdominal pain, jaundice, respiratory distress, or neurological deficits, and can lead to severe complications, such as cyst rupture, allergic reactions, sepsis, or secondary hydatidosis. Imaging plays a key role in evaluating cyst stage, size, location, and potential complications, as well as in determining the appropriateness of a minimally invasive PAIR procedure. Although serum antibody tests typically have a low sensitivity, antigen assays or recombinant proteins may provide useful diagnostic information. For uncomplicated active cysts, the treatment options include chemotherapy alone or in combination with the PAIR technique. Hepatic echinococcal cysts, which are relatively rare in North America, should be considered in the differential diagnosis of hepatic cysts, especially in individuals with risk factors.