A 30-year-old woman with a symptomatic hepatic hydatid cyst is planned for percutaneous aspiration, injection of scolicidal agent, and reaspiration (PAIR). Which finding on evaluation would be a contraindication to the PAIR procedure?

• A WHO stage CE1 unilocular cyst with double line sign
• B Cyst located in segment VI away from major vessels
• C Demonstrable communication of the cyst with the biliary tree ✓
• D Serum indirect haemagglutination titre positive for Echinococcus

Explanation

Injection of a scolicidal agent such as hypertonic saline into a cyst that communicates with the biliary tree risks chemical sclerosing cholangitis, so biliary communication is an absolute contraindication to PAIR. Inactive or heavily calcified cysts, inaccessible superficial locations, and cysts with daughter cysts in solid organs are other relative exclusions. A simple active CE1 cyst in a peripheral location is precisely the ideal candidate for PAIR.

Reference: Schwartz's Principles of Surgery, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.