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Age: 40

Sex: Male

Indication: Right upper quadrant pain, jaundice

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Case #24


Findings

  • Complex lesion in the right hepatic lobe measuring 5.2 x 4.5 x 4.2 cm with a hyperechoic rim, multiple rounded internal hypoechoic areas, and no internal Doppler flow
  • Otherwise normal appearance of the liver
  • Small volume perihepatic free fluid
  • Borderline dilation of the common bile duct, measuring up to 6-7 mm, without intrahepatic biliary duct dilation
  • Normal appearance of the gallbladder and right kidney
  • Normal appearance of the visualized portion of the pancreas


Diagnosis

Hydatid cyst

Sample Report

Complex lesion in the right hepatic lobe measuring 5.2 x 4.5 x 4.2 cm with multiple internal cystic areas and no internal vascularity. Differential considerations include a multilocular pyogenic abscess, hydatid cyst, and necrotic/cystic neoplasm.

Mild extrahepatic biliary duct dilation without obstructing mass or stone identified. MRCP or ERCP could provide further evaluation.

Small volume perihepatic free fluid, likely reactive.


Discussion

  • Hydatid disease results from infection with the tapeworm Echinococcus granulosus (also Echinococcus multilocularis) and most commonly affects the liver
  • Hydatid disease has a varying imaging appearance as it progresses from an internally simple-appearing cyst to a cyst containing numerous daughter cysts that progressively enlarge, to a disorganized mess with fragments of ruptured cysts and progressive calcification which can even mimic a solid tumor
  • Some clues that you may be dealing with a hydatid cyst include:
    • Thick, echogenic wall with double echogenic lines separated by a hypoechoic stripe
    • Internal echogenic debris (“hydatid sand”) that layers dependently and changes location with changes in patient positioning
    • Daughter cysts may produce a honeycomb or spoke wheel appearance due to their somewhat organized-appearing distribution within the larger cyst by the hydatid matrix
    • Curvilinear internal echogenic lines representing fragmented membranes
  • This case shows a good correlation between ultrasound, CT, and MRI findings (see annotated images)


Images

Complex structure in the right hepatic lobe with a thick, echogenic rim, internal hypoechoic areas, and no internal vascularity (red arrow). Noncontrast CT (on left) and T2-weighted MRI (on right) show a complex lesion in the right hepatic lobe (red arrows) with peripheral calcification best seen on CT and internal cystic areas best seen on MRI. Small volume adjacent perihepatic free fluid (yellow arrow).

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