542 THE ANIMAL PARASITES OP MAN 



mus develop, provided rupture into the pelvis of the kidney and discharge of 

 the cysts have not occurred. The urine which may be voided prior to, with, 

 or after, the discharge of the cyst is turbid, occasionally of a soapy-alkaline, 

 milky, or turbid appearance, and in the sediment the characteristic contents of 

 the cyst are found. After discharge the palpable tumor disappears, to recur 

 after some time. The affection may last for many years. Occasionally the 

 echinococcus takes other roads ; perforation into the pleural cavity and abdom- 

 inal cavity has repeatedly been observed. 



Eenal echinococcus differs from cysts of the liver and of the spleen by the 

 immobility at its base, by its outlines which may be determined by percussion 

 from the borders of these organs, and by dislocation of the colon. The differ- 

 ential diagnosis between renal echinococcus and hydronephrosis is very diffi- 

 cult. The history of the development of the tumor, the proof of a hindrance 

 to the discharge of urine, the previous presence of renal calculi or of a stasis 

 pyelitis, point to the presence of hydronephrosis. 



The prognosis of renal echinococci is considered by most authors to be very 

 grave. Fortunately, with the advance of modern surgery, operative treatment 

 gives better results than formerly. 



In the adrenals only one case each of the cystic and of the multilocular 

 form has up to the present been found. 



Echinococcus of the urinary Madder has been reported by Hinsworth and 

 Schonfeld. 



Winterberg has described a case of echinococcus of the prostate gland. 



Echinococci in the ahdominal cavity. Primary cysts of the peritoneum 

 appear to be rare. They are always multiple. Their origin may be referred 

 to a profound general infection or to an autoinfection. The parasite is 

 usually found simultaneously in other organs. Numerous adhesions may fre- 

 quently preclude the determination of the point of origin. The symptoms 

 which result are due to the pressure exerted upon the abdominal organs. 

 Perforation is rare. 



Primary retroperitoneal echinococci are not often found except in the 

 connective tissue of the pelvis and in the female genitalia, where the cysts 

 are situated subserously. In the Pomeranian statistics we find only one ease 

 of this kind described by Bitter. Karewski recently published two cases. The 

 symptomatology is usually obscure, and when suppuration takes place it points 

 to a perinephritic abscess. On account of the pressure of the thick layers of 

 muscles and of the bones of the trunk, held by tense fascia, the echinococcus 

 finds but little room for growth, and is forced to develop from the surface 

 by daughter- and granddaughter-cysts of exogenous growth. Conspicuous 

 symptoms appear only when suppuration occurs. To facilitate the diagnosis, 

 Karewski advises exploratory puncture, all danger being obviated by the extra- 

 peritoneal position. 



Echinococci of the mesentery are somewhat infrequent, and their diagnosis 

 is not easy. In regard to their differentiation from cysts of the omentum, 

 Hahn states that the latter can come into question only when fixed loops of 

 intestine can be determined between the tumor and the abdominal wall, or in 

 the surroundings of the tumor, or in the limits which may be defined by 



