Answer for BIR CoW 08 Sep 2024
Hepatic Hydatid Cyst – Stage CE3b
Findings:
Evidence of a large, well-defined, multilobulated cystic lesion noted occupying both lobes of the liver, with relative sparing of Segment 8.
Multiple round cysts are observed arranged at the periphery of the lesion.
There is minimal extra-capsular extension of the lesion in the lateral segment.
The lesion shows few patchy areas of diffusion restriction with low ADC values.
Mild intrahepatic biliary radicle (IHBR) dilatation in the left lobe of the liver due to compression.
Hepatomegaly noted, measuring 20 cm.
No free fluid detected.
Discussion
Hepatic hydatid disease is a parasitic zoonosis caused by the Echinococcus tapeworm. Echinococcus granulosus Echinococcus multilocularis MRI T1: mixed low signal (depending on the amount of proteinaceous cellular debris) T2: mixed high signal (depending on the amount of proteinaceous cellular debris), septa and daughter cysts are well visualized (especially on single-shot T2 sequences) T1 C+ (Gd): enhancing walls and septa the WHO Informal Working Group on Echinococcosis (WHO-IWGE) classification of hydatid cysts assigned six cyst stages into three clinical groups as follows: (1) The “active” group of developing cysts, which may be unilocular (CE1), or multivesicular with daughter vesicles (CE2), which are usually fertile cysts containing viable protoscoleces. (2) The “transitional” group, which may be cysts with a detachment of the endocyst membrane (CE3a), or predominantly solid cysts with daughter vesicles inside it (CE3b). (3) The “inactive” group includes solid contents (CE4), or solid contents with calcification (CE5), which are almost always nonviable. The WHO classification provides a rational basis for choosing the appropriate treatment scheme and follow-up
REFERENCE:
Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa C. Hydatid Disease: Radiologic and Pathologic Features and Complications. Radiographics. 2000;20(3):795-817. doi:10.1148/radiographics.20.3.g00ma06795 - Pubmed
Findings:
Evidence of a large, well-defined, multilobulated cystic lesion noted occupying both lobes of the liver, with relative sparing of Segment 8.
Multiple round cysts are observed arranged at the periphery of the lesion.
There is minimal extra-capsular extension of the lesion in the lateral segment.
The lesion shows few patchy areas of diffusion restriction with low ADC values.
Mild intrahepatic biliary radicle (IHBR) dilatation in the left lobe of the liver due to compression.
Hepatomegaly noted, measuring 20 cm.
No free fluid detected.
Discussion
Hepatic hydatid disease is a parasitic zoonosis caused by the Echinococcus tapeworm. Echinococcus granulosus Echinococcus multilocularis MRI T1: mixed low signal (depending on the amount of proteinaceous cellular debris) T2: mixed high signal (depending on the amount of proteinaceous cellular debris), septa and daughter cysts are well visualized (especially on single-shot T2 sequences) T1 C+ (Gd): enhancing walls and septa the WHO Informal Working Group on Echinococcosis (WHO-IWGE) classification of hydatid cysts assigned six cyst stages into three clinical groups as follows: (1) The “active” group of developing cysts, which may be unilocular (CE1), or multivesicular with daughter vesicles (CE2), which are usually fertile cysts containing viable protoscoleces. (2) The “transitional” group, which may be cysts with a detachment of the endocyst membrane (CE3a), or predominantly solid cysts with daughter vesicles inside it (CE3b). (3) The “inactive” group includes solid contents (CE4), or solid contents with calcification (CE5), which are almost always nonviable. The WHO classification provides a rational basis for choosing the appropriate treatment scheme and follow-up
REFERENCE:
Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa C. Hydatid Disease: Radiologic and Pathologic Features and Complications. Radiographics. 2000;20(3):795-817. doi:10.1148/radiographics.20.3.g00ma06795 - Pubmed
Note:
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!
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!