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SOLITARY HYDATID CYST IN PELVIS

Images

USG

PLAIN RADIOGRAPH OF ABDOMEN

IVP

CT SCAN

CTSCAN


Clinical History:

A 60-year-old man had a IVP done revealing
right lower ureteric calculus with grade 2 right sided hydroureteronephrosis . Two weeks later USG was done which revealed focal thickening seen at the right VUJ and a well defined predominantly hypoechoic mass lesion in right iliac fossa along posterolateral wall of urinary bladder .Patient then had a CT scan done which revealed a well defined non enhancing mass lesion along the right internal iliac vessels in relation to superolateral aspect of the urinary bladder on the right side with coarse calcifications . Patient was adviced FNAC which revealed thick whitish mucoid like secretions.Smears show laminated membranes with calcified material with few hooklets -CALCIFIED HYDATID CYST.


Findings:

USG showing a well defined predominantly hypoechoic mass lesion in right iliac fossa along posterolateral wall of urinary bladder .
CT scan showing well defined non enhancing mass lesion along the right internal iliac vessels in relation to superolateral aspect of the urinary bladder on the right side with coarse calcifications .


Diagnosis:

Isolated Retrovesical Hydatid Cyst .An Unusual Presentation of Echinococcosis


Discussion:

Hydatid disease (HD) is a unique parasitic disease that is endemic in many parts of the world. HD can occur almost anywhere in the body and demonstrates a variety of imaging features that vary according to growth stage, associated complications, and affected tissue. Radiologic findings range from purely cystic lesions to a completely solid appearance. Calcification is more common in HD of the liver, spleen, and kidney. HD can become quite large in compressible organs. Hydatid cysts (HCs) can be solitary or multiple. Chest radiography, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) imaging, and even urography can depict HCs. The imaging method used depends on the involved organ and the growth stage of the cyst. US most clearly demonstrates the hydatid sands in purely cystic lesions, as well as floating membranes, daughter cysts, and vesicles. CT is best for detecting calcification and revealing the internal cystic structure posterior to calcification. MR imaging is especially helpful in detecting HCs of the central nervous system. Radiologic and serologic findings can generally help establish the diagnosis of HD, but an HC in an unusual location with atypical imaging findings may complicate the differential diagnosis.


References / Suggested Reading:

1. Lewall DB, McCorkell SJ. Hepatic echinococcal
cyst: sonographic appearance and classification.
Radiology 1985; 155:773–775.
2. von Sinner W, te Strake L, Clark D, et al. MR imaging
of HD. AJR Am J Roentgenol 1991; 157:
741–745.
3. Kalovidouris CA, Pissiotis C, Pontiflex G, et al.
CT characterization of multivesicular hydatid
cysts. J Comput Assist Tomogr 1986; 10:428–
431.
4. Kilani T, El Hammami S, Horchani H, et al. HD
of the liver with thoracic involvement. World
J Surg 2001; 25:40–45.
5. Dahniya MH, Hanna RM, Ashebu S, et al. The
imaging appearance of HD at some unusual sites.
Br J Radiol 2001; 74:283–289.


Author

ANSHU MAHAJAN

POST GRADUATE STUDENT,MD

ASCOMS ;J&K

vdogra's picture
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Joined: 12/09/2007
Excellent case.

Excellent case.

Vikram Dogra, MD Professor of Radiology,Urology & BME University of Rochester, NY