All of the following are the indications for PAIR treatment in hydatid cysts, EXCEPT:
Treatment of the hydatid cysts: The treatment of hydatid disease involve the use of oral anthelmintics such as albendazole. Albendazole therapy is the mainstay of treatment in the majority of patients with hydatid disease. It is given alone and for prolonged periods of time in patients who are poor candidates for cyst-directed interventions. However, liver-directed treatment is prefered. The treatment of hepatic cysts is primarily surgical.In General, most cysts are treated. Packing off of the abdomen is impoant because rupture can results in anaphylaxis and diffuse seeding. Usually the cyst is then aspirated through a closed suction system and flushed with a scolicidal agent such as hypeonic saline. The cyst is then unroofed, which can be followed by a number of possibilities, such as excision (or pericystectomy), marsupialization procedures, leaving the cysts open, draining of the cyst, omentoplasty, or paial hepatectomy to encompass the cyst. Total pericystectomy or formal paial hepatectomy can also be performed without entering the cysts. In patients with anatomically appropriate lesions, PAIR ( puncture,aspiration,injection, and reaspiration) is the preferred initial treatment. The efficacy of PAIR in managing hydatid cysts is greater than 75%. For patients whose disease is refractory to PAIR, laparoscopic or open complete cyst removal with instillation of a scolicidal agent generally is curative. Ref: CSDT 11/e, page 128-29 ; Sabiston 18/e page 494-95 ; L&B 25/e, page 56-59
Size > 5cm
Multiloculated
Cyst in lung
Recurrence after surgery