CASE 5932 Published on 23.04.2007
0

Non complicated liver hydatid cyst

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Bello A, González C,Gómez N, Santana. A, Alventosa E, Vivancos J.*, Pascual S*, Rodríguez S*, Fuentes J*. Radiology dep. Section Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain.

Connected authors
Patient

18 years, female

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Clinical History
Patient with acute right upper quadrant abdominal pain.
Imaging Findings
Patient with acute right upper quadrant pain, a temperature of 38.5ºC and 14.000 Leukocites who is refered to our institution in order to perform US and CT if necessary. At US is discovered a cystic mass measuring 11x 8x 9 cm with a hiperechogenic circular structure component. Because of this findings, it is proposed the following differential diagnosis: 1) Hydatid cyst. 2) abscess (amebian, pyogenic) . 3) Byle ducts cystadenoma – cystadenocarcinoma 4) cystic metastasis. A CT was performed in order to focus the diagnosis. The images showed a no enhancement cystic lesion with a dense circular area of increased attenuation values which was interpreted as detached membranes of an hydatid cyst. As CT scan didn´t reveal findings suggestive of complications the diagnosis of non complicated liver hydatid cyst was established. Finally the patient underwent surgery that confirmed the diagnosis.
Discussion
Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. The two main types of hydatid disease are caused by E granulosus and E multilocularis. An hytadid cyst has three layers. The outer layer, or pericyst, the middle laminated membrane and the inner germinal layer (endocyst). Scolices, the infectious embryonic tapeworms, develop from an outpouching of the germinal layer known as the brood capsule. The right lobe is the most frequently involved portion of the liver. Imaging findings in hepatic hydatid disease depend on the stage of cyst growth (ie, whether the cyst is unilocular, contains daughter vesicles, contains daughter cysts, is partially calcified, or is completely calcified [dead]). Detachment of the endocyst from the pericyst is probably related to decreasing intracystic pressure, degeneration, host response, trauma, or response to therapy. The cyst may appear as a well-defined fluid collection with a localized split in the wall and "floating membranes" inside the cavity. Complete detachment of the membranes inside the cyst has been referred to as the US water lily sign because of its resemblance to the radiographic water lily sign in pulmonary cysts. US is the most sensitive modality for the detection of membranes, septa, and hydatid sand within the cyst.
Differential Diagnosis List
Non Complicated liver hydatid cyst.
Final Diagnosis
Non Complicated liver hydatid cyst.
Case information
URL: https://www.eurorad.org/case/5932
DOI: 10.1594/EURORAD/CASE.5932
ISSN: 1563-4086
Figure 1

1. Abdominal ultrasound

1. Abdominal ultrasound
Figure 1: Cystic lesion at right hepatic lobe. Circular image with an hiperechogenic circular structure inside.
1. Abdominal ultrasound
Figure 2. Outpouching of the germinal layer known as the brood capsule. (arrow).
Figure 2

2. Abdominal contrast CT.

2. Abdominal contrast CT.
Figure 3. Hydatid cyst with collapsed parasitic membranes. Contrast CT scan shows a dense circular area of increased attenuation within the cyst representing detached membranes (arrows)