Answer for CoW 22 Jan 2017
Hydatid cyst liver and left subphrenic space
Findings
Given sequences are T2 haste coronal and axial . Location – right lobe of liver and left subphrenic space. Outer layer of large cyst ( pericyst ) has peripheral hypo intense rim – characteristic sign of hydatid Liver. Multiple daughter cysts are arranged peripherally. Twisted linear structures within the cyst – represents collapsed parasitic membranes.
Discussion
Hepatic hydatid cysts may have a low-signal-intensity rim on T2-weighted magnetic resonance (MR) images. This finding has been proposed as a characteristic sign of hydatid disease. It probably represents the outer layer of the hydatid cyst (pericyst), which is rich in collagen and is generated by the host . Peritoneal Seeding.—Peritoneal echinococcosis is almost always secondary to hepatic disease, although some unusual cases of primary peritoneal involvement have been described . The overall frequency of peritoneal disease in cases of echinococcosis involving the abdomen is approximately 13% . Most of these cases are related to previous surgery for hepatic disease, although spontaneous, asymptomatic microruptures of hepatic cysts into the peritoneal cavity are not uncommon . classification type I: simple cyst with no internal architecture type II: cyst with daughter cyst(s) and matrix type IIa: round daughter cysts at periphery type IIb:larger, irregularly shaped daughter cysts occupying almost the entire volume of the mother cyst type IIc: oval masses with scattered calcifications and occasional daughter cysts type III: calcified cyst (dead cyst) type IV: complicated cyst, e.g. ruptured cyst
Findings
Given sequences are T2 haste coronal and axial . Location – right lobe of liver and left subphrenic space. Outer layer of large cyst ( pericyst ) has peripheral hypo intense rim – characteristic sign of hydatid Liver. Multiple daughter cysts are arranged peripherally. Twisted linear structures within the cyst – represents collapsed parasitic membranes.
Discussion
Hepatic hydatid cysts may have a low-signal-intensity rim on T2-weighted magnetic resonance (MR) images. This finding has been proposed as a characteristic sign of hydatid disease. It probably represents the outer layer of the hydatid cyst (pericyst), which is rich in collagen and is generated by the host . Peritoneal Seeding.—Peritoneal echinococcosis is almost always secondary to hepatic disease, although some unusual cases of primary peritoneal involvement have been described . The overall frequency of peritoneal disease in cases of echinococcosis involving the abdomen is approximately 13% . Most of these cases are related to previous surgery for hepatic disease, although spontaneous, asymptomatic microruptures of hepatic cysts into the peritoneal cavity are not uncommon . classification type I: simple cyst with no internal architecture type II: cyst with daughter cyst(s) and matrix type IIa: round daughter cysts at periphery type IIb:larger, irregularly shaped daughter cysts occupying almost the entire volume of the mother cyst type IIc: oval masses with scattered calcifications and occasional daughter cysts type III: calcified cyst (dead cyst) type IV: complicated cyst, e.g. ruptured cyst
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!