Sanjeeb Kumar Sarma (Down Town Hospital / Guwahati / India)  

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7 Years  

Male  

Abdomen-Liver  

inflammatory or infectious  

Seven year old male child presented with history of recurrent rash all over the body since last six months. History of occasional abdominal pain was there.  

Hydatid disease of liver is caused by larvae of a tapeworm called Echinococcus. Two forms exist, Echinococcus granulosus and Echinococcus multilocularis. Former one is more common. Our present case is a Hydatid cyst due to E. granulosus.
In echinococcal disease caused by E. granulosus, dogs are definitive hosts and humans become occasional intermediate host by ingesting material contaminated by dog feces. The eggs hatch within the intestinal tract of the host and penetrate the intestinal mucosa, entering the lymphatic and portal venous system. Most are then filtered by liver and lungs, thus accounting for the high rate of cyst development in the liver (up to 75% of cases) and lungs.
The cyst may be solitary or multiple. The wall of the cyst contains three layers: (1) the pericyst, the outer layer; (2) endocyst, the inner germinal layer containing the growing parasites; (3) the ectocyst, an intermediate layer.
Daughter cysts may develop within the parent cyst as a result of fragmentation of the germinal layer.
Hydatid cyst of liver may remain asymptomatic for many years, become painful only after attaining large size. Often discovered incidentally. Complications are related to rupture, which may lead to anaphylactic reaction. Serologic tests are positive in more than 80% cases.
Treatment is anti parasitic drugs and surgical removal  

<- view CT 1

CT 1: Non contrast CT image showing an approx 67x46 mm sized well defined hypodense/cystic lesion with thin walled septations or loculations involving segment V and VI.




<- view CT 2

CT 2: Post contrast CT section showing multiple small cystic lesions of varying sizes with enhancement of its wall within the main lesion .



<- view CT 3

CT 3: Post contrast axial CT image at a lower level showing multiple cystic lesions within the main lesion clearly.



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CT 4: Reformatted coronal CT image showing multiple cystic lesions in the right lobe of liver.


 

Laboratory diagnostics  

Hepatic abscess, Polycystic liver disease.  

Prognosis is good.The disease responds well to medical treatment.Surgical treatment may be required if complications arise or medical treatment does not respond well.  

Following the history of abdominal pain USG of abdomen was done outside where it was diagnosed as abscess of right lobe of liver. CT features were diagnostic. Serologic test was confirmatory.
Clinically the patient responds well to antiparasitic drugs.  

N/A  

1. Medline:
1. Haaga J R et al. CT and MR evaluation of Whole Body.Mosby.4th Ed. Vol.2 Ch. 35.P 1309-1311.  

Hydatid, Echinococcus, Human, Intermediate host, child, childhood, pediatric radiology  

Sanjeeb Kumar. Hydatid Cyst of Liver. PedRad [serial online] vol 9, no. 5.
URL: www.PedRad.info/?search=20090503132547