DOI: 10.1148/rg.232025704
Hydatid Disease from Head to Toe1
Pinar Polat, MD,
Mecit Kantarci, MD,
Fatih Alper, MD,
Selami Suma, MD,
Melike Bedel Koruyucu, MD and
Adnan Okur, MD
1 From the Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey. Received April 15, 2002; revision requested June 11 and received August 16; accepted August 19. Address correspondence to P.P., Istasyon mah, Kombina cad, Armagan Apt 4/7, Erzurum, Turkey (e-mail: drppolat@hotmail.com).
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Figure 1. Incidentally found type I HCs in a 45-year-old woman. Computed tomographic (CT) scan shows multiple unilocular hypoattenuating lesions in the liver (maximum lesion diameter, 15 mm) and spleen (maximum lesion diameter, 30 mm) and one lesion in the tail of the pancreas. The presence of multiple hypoattenuating lesions suggests polycystic liver disease. Casoni and Weinberg test results were positive, and fine-needle aspiration biopsy revealed HD.
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Figure 2. Detachment of the endocyst from the pericyst in a type II hepatic cyst. Contrast material-enhanced CT scan demonstrates a large, unenhanced cystic lesion with internal floating membranes that occupies almost the entire left hepatic lobe.
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Figure 3. Type IIA hepatic cyst with peripheral calcification. CT scan shows an unenhanced hypoattenuating mass with well-defined borders in the subdiaphragmatic portion of the liver. Multiple round daughter cysts are seen peripherally within the lesion. Note also the peripheral curvilinear wall calcification, which is best seen at CT.
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Figure 4. Type IIB hepatic cyst. CT scan demonstrates a large, unenhanced hypoattenuating mass with irregularly shaped daughter cysts that occupies most of the left hepatic lobe. Note that the daughter cysts occupy almost the entire volume of the mother cyst (rosette sign).
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Figure 5. Rupture of a type IV hepatic cyst into the biliary tree in a 48-year-old man who presented with acute onset of jaundice and pain in the right upper quadrant. CT scan reveals a nonenhancing mass with irregular contours that occupies a small portion of the right hepatic lobe and caudate lobe. Isoattenuating detached membranes appear as serpentine structures within the lesion and protrude into the common bile duct.
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Figure 6. Partially calcified HC. CT scan shows a hypoattenuating lesion with peripheral wall calcification in the right hepatic lobe.
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Figure 7a. HD of the liver with involvement of the diaphragm and thoracic cavity in a 54-year-old man. The patient lived in an endemic region and had previously undergone surgery for hepatic HD. (a) Axial contrast-enhanced CT scan through the dome of the liver shows a hypoattenuating lesion that originates from the posterior segment of the right hepatic lobe and has grown through the diaphragm to the lung. (b) Corresponding axial T2-weighted MR image shows the lesion with a multivesicular appearance, transdiaphragmatic growth, and protrusion into the right lower basal lung segment.
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Figure 7b. HD of the liver with involvement of the diaphragm and thoracic cavity in a 54-year-old man. The patient lived in an endemic region and had previously undergone surgery for hepatic HD. (a) Axial contrast-enhanced CT scan through the dome of the liver shows a hypoattenuating lesion that originates from the posterior segment of the right hepatic lobe and has grown through the diaphragm to the lung. (b) Corresponding axial T2-weighted MR image shows the lesion with a multivesicular appearance, transdiaphragmatic growth, and protrusion into the right lower basal lung segment.
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Figure 8. Type II HC with primary splenic involvement in a 23-year-old woman who lived in an endemic region. The patient had no other organ involvement. Axial contrast-enhanced CT scans through the upper (left) and lower (right) pole of the spleen show a huge, unenhanced low-attenuation mass that occupies almost the entire spleen. Note the peripheral daughter cyst in the superior portion of the mother cyst.
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Figure 9. Primary renal HD in a 26-year-old man who presented with flank pain and signs of a gradually increasing mass in the left upper abdomen. Axial unenhanced CT scan through the middle pole of the kidneys shows a hypoattenuating mass with peripheral daughter cysts and calcification (type II HC).
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Figure 10. Primary HD of the adrenal gland in a 50-year-old man. US image shows a round lesion with mixed echogenicity. Note the serpentine structures within the matrix, a finding that represents collapsed membranes. The diagnosis was made on the basis of US and laboratory findings and was confirmed at surgery.
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Figure 11. Peritoneal HD in a 47-year-old man who had previously undergone surgery for a hepatic HC. Axial contrast-enhanced CT scan through the middle pole of the kidneys shows multiple low-attenuation daughter cysts in the peritoneal cavity.
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Figure 12a. Intraperitoneal HCs and a herniated umbilical sac in a 55-year-old man with a previous history of liver HD. (a) Axial breath-hold fast spin-echo T1-weighted MR image shows multiple low-signal-intensity lesions within the mesenteric fatty tissue. Note also the umbilical hernia and the low-signal-intensity masses within the herniated sac. (b) Corresponding axial rapid acquisition with relaxation enhancement T2-weighted MR image shows multiple areas of increased signal intensity. The hypointense rim sign characteristic of HCs is best seen with this sequence. Note also the multivesicular hepatic cyst within the herniated sac.
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Figure 12b. Intraperitoneal HCs and a herniated umbilical sac in a 55-year-old man with a previous history of liver HD. (a) Axial breath-hold fast spin-echo T1-weighted MR image shows multiple low-signal-intensity lesions within the mesenteric fatty tissue. Note also the umbilical hernia and the low-signal-intensity masses within the herniated sac. (b) Corresponding axial rapid acquisition with relaxation enhancement T2-weighted MR image shows multiple areas of increased signal intensity. The hypointense rim sign characteristic of HCs is best seen with this sequence. Note also the multivesicular hepatic cyst within the herniated sac.
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Figure 13a. Type II retroperitoneal HC. (a) Axial contrast-enhanced CT scan through the pelvis shows an HC with daughter cysts adjacent to the left iliac muscle. In this case, HD was secondary to liver involvement and previous surgery. (b) Axial contrast-enhanced CT scan through the pelvis shows a hypoattenuating mass that contains detached membranes with a serpentine appearance adjacent to the left psoas muscle. The mass represents isolated retroperitoneal involvement.
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Figure 13b. Type II retroperitoneal HC. (a) Axial contrast-enhanced CT scan through the pelvis shows an HC with daughter cysts adjacent to the left iliac muscle. In this case, HD was secondary to liver involvement and previous surgery. (b) Axial contrast-enhanced CT scan through the pelvis shows a hypoattenuating mass that contains detached membranes with a serpentine appearance adjacent to the left psoas muscle. The mass represents isolated retroperitoneal involvement.
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Figure 14a. Secondary involvement of the bladder and retrovesical areas in a 53-year-old woman with a multiyear history of liver and peritoneal HCs. The patient had undergone repeated surgeries. (a) Axial contiguous contrast-enhanced CT scan through the lower pelvis shows low-attenuation masses in the left retrovesical area. The posterolateral bladder wall is seen to protrude into the lumen of the bladder. Note the intralesional calcification, which originates at the right posterolateral wall. In addition, there is a second, densely calcified lesion within the bladder lumen (type III hepatic cyst). (b) Axial contrast-enhanced CT scan obtained 10 mm distal to a shows a hypoattenuating mass with dense peripheral calcification that protrudes into the bladder lumen. (c) Axial contrast-enhanced CT scan obtained 10 mm distal to b shows a third low-attenuation mass that protrudes from the anterior wall of the bladder.
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Figure 14b. Secondary involvement of the bladder and retrovesical areas in a 53-year-old woman with a multiyear history of liver and peritoneal HCs. The patient had undergone repeated surgeries. (a) Axial contiguous contrast-enhanced CT scan through the lower pelvis shows low-attenuation masses in the left retrovesical area. The posterolateral bladder wall is seen to protrude into the lumen of the bladder. Note the intralesional calcification, which originates at the right posterolateral wall. In addition, there is a second, densely calcified lesion within the bladder lumen (type III hepatic cyst). (b) Axial contrast-enhanced CT scan obtained 10 mm distal to a shows a hypoattenuating mass with dense peripheral calcification that protrudes into the bladder lumen. (c) Axial contrast-enhanced CT scan obtained 10 mm distal to b shows a third low-attenuation mass that protrudes from the anterior wall of the bladder.
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Figure 14c. Secondary involvement of the bladder and retrovesical areas in a 53-year-old woman with a multiyear history of liver and peritoneal HCs. The patient had undergone repeated surgeries. (a) Axial contiguous contrast-enhanced CT scan through the lower pelvis shows low-attenuation masses in the left retrovesical area. The posterolateral bladder wall is seen to protrude into the lumen of the bladder. Note the intralesional calcification, which originates at the right posterolateral wall. In addition, there is a second, densely calcified lesion within the bladder lumen (type III hepatic cyst). (b) Axial contrast-enhanced CT scan obtained 10 mm distal to a shows a hypoattenuating mass with dense peripheral calcification that protrudes into the bladder lumen. (c) Axial contrast-enhanced CT scan obtained 10 mm distal to b shows a third low-attenuation mass that protrudes from the anterior wall of the bladder.
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Figure 15. Incidentally found HD with primary ovarian involvement in a 38-year-old woman. Axial contrast-enhanced CT scan shows a low-attenuation lesion in the right ovary. The cyst is unilocular and cannot be differentiated from an ovarian cystadenoma on the basis of CT findings alone. Because of the increasing size of the lesion at follow-up, the patient underwent surgery, which revealed an HC.
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Figure 16. HD with secondary scrotal involvement in a 63-year-old man with multiple HCs in the liver and peritoneum. The patient presented with acute scrotal pain. US image shows a well-demarcated fluid collection with freely floating isoechoic serpentine structures in the left side of the scrotum. These structures were suggestive of the rupture and detached membranes of an HC. Surgery helped confirm the diagnosis.
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Figure 17. Multiple lung HCs in a 28-year-old man. Posteroanterior chest radiograph shows multiple well-defined areas of increased opacity in both lung fields. Note also the thin-walled cavitary lesions in the right lower and bilateral upper zones (arrows).
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Figure 18. Giant HC of the left lung with concomitant liver involvement in a 4-year-old boy. Multiplanar reformatted CT scan shows a giant HC (arrowheads) that occupies almost the entire left lung. A second giant HC (arrows) occupies nearly all of the right hepatic lobe. The compressibility of these organs allows HCs to grow this large.
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Figure 19a. Ruptured type IV HC of the lung. (a) Axial CT scan obtained through the mediobasal segment of the right lung in an 18-year-old man shows the onion peel sign created by air that is trapped between the endocyst and pericyst. Note also the parenchymal consolidation adjacent to the HC. (b) Axial CT scan obtained through the apical segment of the left lower lobe in a 44-year-old woman shows the water lily sign created by collapsed and crumpled endocysts floating freely in the most dependent part of the cyst.
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Figure 19b. Ruptured type IV HC of the lung. (a) Axial CT scan obtained through the mediobasal segment of the right lung in an 18-year-old man shows the onion peel sign created by air that is trapped between the endocyst and pericyst. Note also the parenchymal consolidation adjacent to the HC. (b) Axial CT scan obtained through the apical segment of the left lower lobe in a 44-year-old woman shows the water lily sign created by collapsed and crumpled endocysts floating freely in the most dependent part of the cyst.
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Figure 20a. Primary HD of the pleura. Axial CT scans obtained through the lungs in two different patients show low-attenuation masses with daughter cysts in the left pleura, findings that represent type IIB (a) and type IIA (b) HCs.
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Figure 20b. Primary HD of the pleura. Axial CT scans obtained through the lungs in two different patients show low-attenuation masses with daughter cysts in the left pleura, findings that represent type IIB (a) and type IIA (b) HCs.
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Figure 21. Anterior mediastinal type IIB HC. Axial contrast-enhanced CT scan shows an HC with daughter cysts anterior to the aortic arch and superior vena cava.
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Figure 22. HD of the heart in a 43-year-old man. Axial contrast-enhanced CT scan shows a low-attenuation mass in the left ventricle, a finding that is consistent with type I unilocular HC.
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Figure 23. HD of the heart in a 28-year-old woman. Transverse US image shows a multiloculated anechoic mass with daughter cysts in the right ventricle (arrows), a finding that is consistent with type IIB HC. IVN = interventricular septum, LV = left ventricle, RA = right atrium, RV = right ventricle.
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Figure 24a. HD with pericardial involvement in a 15-year-old boy. (a) Posteroanterior chest radiograph shows deformation of the lung contour at the left border of the heart, which is obscured by a radiopaque lesion. Note also the displacement of the heart to the right. (b) Axial contrast-enhanced CT scan shows a type IIA HC with multiple peripheral daughter cysts. (c) Axial spin-echo T1-weighted MR image also shows a type IIA HC in proximity to the left ventricular wall and displacing the heart to the right.
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Figure 24b. HD with pericardial involvement in a 15-year-old boy. (a) Posteroanterior chest radiograph shows deformation of the lung contour at the left border of the heart, which is obscured by a radiopaque lesion. Note also the displacement of the heart to the right. (b) Axial contrast-enhanced CT scan shows a type IIA HC with multiple peripheral daughter cysts. (c) Axial spin-echo T1-weighted MR image also shows a type IIA HC in proximity to the left ventricular wall and displacing the heart to the right.
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Figure 24c. HD with pericardial involvement in a 15-year-old boy. (a) Posteroanterior chest radiograph shows deformation of the lung contour at the left border of the heart, which is obscured by a radiopaque lesion. Note also the displacement of the heart to the right. (b) Axial contrast-enhanced CT scan shows a type IIA HC with multiple peripheral daughter cysts. (c) Axial spin-echo T1-weighted MR image also shows a type IIA HC in proximity to the left ventricular wall and displacing the heart to the right.
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Figure 25. Type I HC of the brain in a 12-year-old boy. Axial CT scan shows a mass in the left parietal lobe with an attenuation similar to that of cerebrospinal fluid. Note the mass effect and the displacement of the interhemispheric fissure to the right. There is no edema formation adjacent to the cyst.
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Figure 26a. Type IIB HC of the brain in a 17-year-old girl with erosion of the adjacent calvaria. (a) Contrast-enhanced T1-weighted MR image shows a nonenhancing, low-signal-intensity multiloculated mass without edema formation in the right parietal lobe. Note also the mass effect. (b) Axial T2-weighted MR image shows increased signal intensity within the lesion. Daughter cysts are seen that are somewhat hypointense relative to the mother cyst. Note also the low-signal-intensity rim surrounding the daughter cysts. (c) Sagittal T1-weighted MR image clearly delineates the erosion of the parietal bone and the HC protrusion into the subgaleal fatty tissue. (d) Lateral radiograph of the skull shows a radiolucent lytic lesion in the parietal bone. Minimal sclerotic changes are seen at the periphery of the lesion.
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Figure 26b. Type IIB HC of the brain in a 17-year-old girl with erosion of the adjacent calvaria. (a) Contrast-enhanced T1-weighted MR image shows a nonenhancing, low-signal-intensity multiloculated mass without edema formation in the right parietal lobe. Note also the mass effect. (b) Axial T2-weighted MR image shows increased signal intensity within the lesion. Daughter cysts are seen that are somewhat hypointense relative to the mother cyst. Note also the low-signal-intensity rim surrounding the daughter cysts. (c) Sagittal T1-weighted MR image clearly delineates the erosion of the parietal bone and the HC protrusion into the subgaleal fatty tissue. (d) Lateral radiograph of the skull shows a radiolucent lytic lesion in the parietal bone. Minimal sclerotic changes are seen at the periphery of the lesion.
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Figure 26c. Type IIB HC of the brain in a 17-year-old girl with erosion of the adjacent calvaria. (a) Contrast-enhanced T1-weighted MR image shows a nonenhancing, low-signal-intensity multiloculated mass without edema formation in the right parietal lobe. Note also the mass effect. (b) Axial T2-weighted MR image shows increased signal intensity within the lesion. Daughter cysts are seen that are somewhat hypointense relative to the mother cyst. Note also the low-signal-intensity rim surrounding the daughter cysts. (c) Sagittal T1-weighted MR image clearly delineates the erosion of the parietal bone and the HC protrusion into the subgaleal fatty tissue. (d) Lateral radiograph of the skull shows a radiolucent lytic lesion in the parietal bone. Minimal sclerotic changes are seen at the periphery of the lesion.
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Figure 26d. Type IIB HC of the brain in a 17-year-old girl with erosion of the adjacent calvaria. (a) Contrast-enhanced T1-weighted MR image shows a nonenhancing, low-signal-intensity multiloculated mass without edema formation in the right parietal lobe. Note also the mass effect. (b) Axial T2-weighted MR image shows increased signal intensity within the lesion. Daughter cysts are seen that are somewhat hypointense relative to the mother cyst. Note also the low-signal-intensity rim surrounding the daughter cysts. (c) Sagittal T1-weighted MR image clearly delineates the erosion of the parietal bone and the HC protrusion into the subgaleal fatty tissue. (d) Lateral radiograph of the skull shows a radiolucent lytic lesion in the parietal bone. Minimal sclerotic changes are seen at the periphery of the lesion.
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Figure 27a. Multiple infected HD of the brain in a 23-year-old man. The patient had previously undergone surgery for a cerebral HC. (a) Axial T1-weighted MR image shows multiple low-signal-intensity lesions in the occipital lobes bilaterally. (b) Axial contrast-enhanced T1-weighted MR image shows enhancement peripheral to the lesions, a finding that is consistent with infection. (c) T2-weighted MR image demonstrates mixed heterogeneous signal intensity in the occipital lobes. Note also the edema formation, an unusual finding in HC of the brain.
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Figure 27b. Multiple infected HD of the brain in a 23-year-old man. The patient had previously undergone surgery for a cerebral HC. (a) Axial T1-weighted MR image shows multiple low-signal-intensity lesions in the occipital lobes bilaterally. (b) Axial contrast-enhanced T1-weighted MR image shows enhancement peripheral to the lesions, a finding that is consistent with infection. (c) T2-weighted MR image demonstrates mixed heterogeneous signal intensity in the occipital lobes. Note also the edema formation, an unusual finding in HC of the brain.
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Figure 27c. Multiple infected HD of the brain in a 23-year-old man. The patient had previously undergone surgery for a cerebral HC. (a) Axial T1-weighted MR image shows multiple low-signal-intensity lesions in the occipital lobes bilaterally. (b) Axial contrast-enhanced T1-weighted MR image shows enhancement peripheral to the lesions, a finding that is consistent with infection. (c) T2-weighted MR image demonstrates mixed heterogeneous signal intensity in the occipital lobes. Note also the edema formation, an unusual finding in HC of the brain.
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Figure 28a. Extradural-intraspinal and paravertebral HD secondary to the spread of vertebral HD in a 36-year-old man. (a) Axial spin-echo T1-weighted MR image through the L3 vertebra shows multiple hypointense masses in the vertebral body and the paravertebral and extradural-intraspinal areas. (b) Corresponding axial fast spin-echo T2-weighted MR image shows multiple areas of increased signal intensity. Note that the extradural-intraspinal masses have low-signal-intensity rims. There is also marked destruction of the right anterolateral portion of the vertebral body.
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Figure 28b. Extradural-intraspinal and paravertebral HD secondary to the spread of vertebral HD in a 36-year-old man. (a) Axial spin-echo T1-weighted MR image through the L3 vertebra shows multiple hypointense masses in the vertebral body and the paravertebral and extradural-intraspinal areas. (b) Corresponding axial fast spin-echo T2-weighted MR image shows multiple areas of increased signal intensity. Note that the extradural-intraspinal masses have low-signal-intensity rims. There is also marked destruction of the right anterolateral portion of the vertebral body.
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Figure 29. HD with thyroid tissue involvement in a 23-year-old woman. Axial CT scan through the upper mediastinum shows a hypoattenuating mass with dense peripheral calcification. The lesion compresses the trachea and displaces it to the left. A diagnosis of multinodular goiter was made, and the patient underwent surgery, which revealed concomitant thyroid nodules and HC with dense wall calcification.
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Figure 30a. Type II HC with muscle involvement in a 22-year-old woman. (a) On a color Doppler US image, edema or acute inflammation caused by compression of or allergic reaction in soft tissue adjacent to the cyst manifests as increased color signal. (b) Transverse gray-scale US image shows an anechoic mass that contains floating echogenic membranes, a finding that is consistent with HC.
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Figure 30b. Type II HC with muscle involvement in a 22-year-old woman. (a) On a color Doppler US image, edema or acute inflammation caused by compression of or allergic reaction in soft tissue adjacent to the cyst manifests as increased color signal. (b) Transverse gray-scale US image shows an anechoic mass that contains floating echogenic membranes, a finding that is consistent with HC.
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Figure 31. Primary type I HC of the psoas muscle in a 46-year-old woman who presented with symptoms of low back pain. Axial T2-weighted MR image shows a hyperintense mass in the right psoas muscle.
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Figure 32a. Soft-tissue HD in a 27-year-old man who presented with palpable masses at the dorsal surface of the left ankle. (a) Sagittal proton-density-weighted MR image shows a low-signal-intensity mass with a hypointense rim at the dorsal surface of the left ankle. (b) Axial T2-weighted MR image shows multiple homogeneous masses with increased signal intensity. Note also the hypointense rim at the periphery of the lesions.
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Figure 32b. Soft-tissue HD in a 27-year-old man who presented with palpable masses at the dorsal surface of the left ankle. (a) Sagittal proton-density-weighted MR image shows a low-signal-intensity mass with a hypointense rim at the dorsal surface of the left ankle. (b) Axial T2-weighted MR image shows multiple homogeneous masses with increased signal intensity. Note also the hypointense rim at the periphery of the lesions.
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Figure 33. Vertebral HD with secondary spinal canal involvement in a 45-year-old woman who presented with symptoms of low back pain and paresthesia of the lower extremities. Axial contrast-enhanced CT scan through the L1 vertebra shows multiple lytic lesions in the vertebral body. The lesion extends into paravertebral soft tissue and the spinal canal. There is also a hypoattenuating oval lesion in the erector spina muscles. Note the increased contrast enhancement peripheral to the lesions in the erector spina muscles and spinal canal.
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Copyright © 2003 by the Radiological Society of North America.
