EURORAD ESR

Case 14407

Rupture of an echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis

Author(s)
Leonardo Giarraputo, Sergio Savastano, Alessandra Costantini, Stefano Trupiani, Valeria Borile

U.O. Radiologia, Ospedale San Bortolo - V.le F. Rodolfi 37 36100 Vicenza, Italy;
 
Patient
female, 25 year(s)
 
 
  • Figure 1
    Abdominal cystic echinococcosis: ultrasonography.
     

    The left hepatic lobe contains an inhomogeneous cyst (CE4). A large splenic cyst (CE1) is just below visible.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Parasites;

    A CE2 cyst is evident among bowel loops.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Parasites;

    A CE3 collapsed cyst is detected at the left flank.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 2
    Abdominal cystic echinococcosis: non-enhanced CT scans.
     

    Uniloculated hepatic cyst and large splenic cyst with irregular border and hyperattenuating septum, consistent for contained rupture.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    The hepatic cyst shows hyperattenuating rim on caudal level.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Collapsed cyst with hyperattenuating rim at the left flank.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    On more caudal level air bubble within the collapsed cyst is appreciable; fluid collection surrounds the descendent colon. Another cyst with hyperattenuating rim is also shown.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 3
    Abdominal cystic echinococcosis: contrast-enhanced CT scans.
     

    The collapsed cyst appears inhomogeneous on post-contrast image.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    The cyst appears medially attached to the descendent colon, displaced and angulated.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 4
    Abdominal cystic echinococcosis: contrast-enhanced CT reformations.
     

    Sagittal reformations (left side) shows multiple cyst in different evolutive phases.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Coronal reformation

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Magnification of Fig. 4b: cysto-colonic communication (arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 5
    WHO sonographic classification of hepatic hydatid disease

    WHO classification of hydatyd hepatic cyst according with status and ultrasonographic appareance (from ref. 4)

     
    Area of Interest: Education; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Parasites;
     
     
The left hepatic lobe contains an inhomogeneous cyst (CE4). A large splenic cyst (CE1) is just below visible.
 
A CE2 cyst is evident among bowel loops.
 
A CE3 collapsed cyst is detected at the left flank.
 
Uniloculated hepatic cyst and large splenic cyst with irregular border and hyperattenuating septum, consistent for contained rupture.
 
The hepatic cyst shows hyperattenuating rim on caudal level.
 
Collapsed cyst with hyperattenuating rim at the left flank.
 
On more caudal level air bubble within the collapsed cyst is appreciable; fluid collection surrounds the descendent colon. Another cyst with hyperattenuating rim is also shown.
 
The collapsed cyst appears inhomogeneous on post-contrast image.
 
The cyst appears medially attached to the descendent colon, displaced and angulated.
 
Sagittal reformations (left side) shows multiple cyst in different evolutive phases.
 
Coronal reformation
 
Magnification of Fig. 4b: cysto-colonic communication (arrow).
 
WHO classification of hydatyd hepatic cyst according with status and ultrasonographic appareance (from ref. 4)
 
 
 
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