CardioVascular and Interventional Radiology

, Volume 28, Issue 2, pp 200–208 | Cite as

Modified PAIR Technique for Percutaneous Treatment of High-Risk Hydatid Cysts

  • Abdelwahab M. GabalEmail author
  • Fazal I. Khawaja
  • Ghanem A. Mohammad



This paper presents a modification of the known method for percutaneous treatment of hydatid cyst, the PAIR technique. It aimed to achieve safe aspiration of large symptomatic cysts and cysts with a danger of impending rupture.


We designed a coaxial catheter system to achieve concomitant evacuation of cyst contents while infusing scolicidal agent. Hypertonic saline is used to wash out cyst contents and to kill protoscolices. This was followed by injection of a sclerosant (ethyl alcohol 95%) into the residual cyst cavity to prevent formation of a cyst collection after the procedure. Seventeen cysts in 14 patients were successfully aspirated. Follow-up plain radiographs, ultrasonography and CT were performed weekly in the first 4 weeks and then at 3, 6 and 12 months for all patients. Seven patients (9 drained cysts) were followed up for 2 years and 1 patient for 3 years.


All cysts were successfully aspirated. The following morphologic changes were noticed: a gradual decrease in cyst size (17 cysts, 100%), thickening and irregularity of the cyst wall due to separation of endocyst from pericyst (7 cysts, 41%), development of a heterogeneous appearance of the cyst components (8 cysts, 47%) and development of pseudotumor (2 cysts, 12%). None of the treated cysts disappeared completely. No significant procedure-related complications were encountered.


This modified PAIR technique is a reliable method for percutaneous treatment of risky and symptomatic hydatid cysts.


Absolute alcohol Hydatid cyst Hypertonic saline Modified PAIR Percutaneous treatment of lung hydatid cyst 


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Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Abdelwahab M. Gabal
    • 1
    Email author
  • Fazal I. Khawaja
    • 2
  • Ghanem A. Mohammad
    • 3
  1. 1.Department of RadiologyKing Fahad HospitalMadinahSaudi Arabia
  2. 2.Department of Gastroenterology and Gastrointestinal EndoscopyKing Fahad HospitalMadinahSaudi Arabia
  3. 3.Department of Chest DiseasesAl-azhar University Medical CenterCairoEgypt

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