Hydatid cyst is a very common disease caused by Ecinococcusgranulosumlarva . It can involve nearly any part of the body but most commonly affected organs are liver and lungs. Ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are valuable radiological investigations to diagnose hydatid cysts. Understanding of disease trend is important for early diagnosis and prevention of its com-plication to occur. We present a case series on a few interesting cases of hydatid cysts in paediatric age group in different organs and stages.
The infection of the meta cestode stage of Echinococcus tapeworms is the cause of echinococcal illness. Ingested eggs from soil or water tainted by canine feces can infect humans, who are incidental hosts. Its embryos travel through the intestinal mucosa and enter the liver via portal vein, where the majority of the larvae encyst. Sometimes larvae can make it to the lungs and occasionally they can even make it past the liver and lung capillary filters and into the bloodstream. From bloodstream it can infect any organs. Although hydatid cysts can form in any organ in the body, they most commonly affect liver (50–80%) and lungs (15–47%). [1]
Case series of four hydatid cyst cases:
Multiple cystic lesions of variable sizes are also noticed in bilateral lobes of the liver on Ultrasound. All these findings are suggestive of disseminated cerebral hydatid cysts. (CE GRADE 3A).
Case 2 is a 12-year boy who has a history of cough, chest pain, and dyspnea. He was referred to the department of radiology for a Chest Xray.
On chest X-ray, a well-defined rounded radiopaque lesion is visible in the right middle zone. Underlying bones are normal. Cardiac silhouette is maintained, trachea is central. Following it patient underwent CT for further evaluation. On HRCT, the right middle lobe has a well-defined thick-walled cystic lesion with focal costal pleura thickening and normal surrounding lung, suggestive of lung hydatid (CL). On axial T2 MRI, round hyperintense cystic lesion in the right middle lobe is noted.
Case 3 is a 15-year boy who presented with a history of pain abdomen. He was a previously diagnosed case of liver hydatid cyst and has undergone PAIR on one of the largest cysts. He was referred to the department of Radiology for a routine follow up ultrasound. On ultrasound there are multiple complex cystic lesions in liver parenchyma, with one of the cysts at segment VIII appearing to be ruptured and extending to the thorax. Some of the cysts show internal floating membrane. Few complex cysts are also seen in peritoneal Spaces (peri splenic, pelvis and left para colic gutter) suggestive of disseminated hydatid. On CT scan there is evidence of multiple variables sized well defined, mildly thick walled, rounded fluid attenuation hypodense lesions in both the lobes of liver, largest one in the right lobe (showing multilocation suggestive of daughter cysts). Multiple lesions are causing mass effect over biliary channels at porta causing mild intrahepatic biliary dilatation. Few of the cysts also show detached laminated membrane. There is evidence of air foci seen in one of the cysts which was treated with PAIR therapy previously. There is also evidence of diffuse, variable sized, predominantly large similar kind of lesions in peritoneal Spaces (peri splenic, pelvis and left para colic gutter). All the above findings are suggestive of liver hydatid disseminated into peritoneal spaces (grade CE3).
Case 4 is a 12-year female with history of pain abdomen, was referred to the department of radiology for an ultrasound scan. On imaging a well-defined cystic lesion with internal floating membrane giving water lily sign is seen in the segment VII of liver along with a focus of fat seen in the nondependent part of the cyst. Another small cyst is noted in the segment III of the left lobe of liver.
Axial CT shows rounded thin-walled cystic lesion in segment VII of liver with detached irregular laminated membrane corresponding to the detached daughter cyst. Two hypodense foci are seen in the nondependent part of the cyst likely fat. There is no evidence of perilesional edema, internal /peripheral calcification. (Grade CE3A hydatid)
Another cystic lesion with hyper dense periphery and discrete density internal content is seen in segment III of liver. (CE4 Hydatid).
Axial T2 MRI beautifully demonstrates WATER LILY SIGN (camalote sign) which occurs due to the detached endocyst.
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