A 35-year-old farmer presents with right upper quadrant pain and eosinophilia. Ultrasound shows a 7 cm cyst with internal echoes and a 'hydatid sand' sign. Serological testing (ELISA) is positive for Echinococcus. The safest intervention after medical therapy is:
- A Emergency surgical excision without drainage
- B PAIR (Puncture, Aspiration, Injection of hypertonic saline, Re-aspiration) with albendazole cover ✓
- C Percutaneous injection of 95% ethanol
- D ERCP with stent placement
Correct answer: B. PAIR (Puncture, Aspiration, Injection of hypertonic saline, Re-aspiration) with albendazole cover
Explanation
PAIR with perioperative albendazole is WHO-endorsed minimally invasive therapy for uncomplicated hepatic hydatid cysts; hypertonic saline acts as a scolicidal agent. Unprotected surgical excision risks spillage of protoscolices causing anaphylaxis and secondary dissemination. Ethanol injection is used for hepatocellular carcinoma ablation. ERCP is indicated for biliary complications, not primary cyst removal.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.