Echinococcus Leber

Left
ventricle hydatid cyst. Cystic lesion inside the left ventricle with multiple cystic lesions in the liver and multiple cystic lesions in the peritoneum.
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Hepatic
hydatid infection • Hydatid cyst of the liver and left broad ligament - Ganzer Fall bei Radiopaedia
Salam, H. Hydatid cyst of the liver and left broad ligament. Case study, Radiopaedia.org. (accessed on 31 Oct 2022) https://doi.org/10.53347/rID-8264 • CC by-nc-sa 3.0 (modified)
Cystic
lesions of the liver (differential) • Hydatid cyst of the liver - Ganzer Fall bei Radiopaedia
Gaillard, F. Hydatid cyst of the liver. Case study, Radiopaedia.org. (accessed on 27 Oct 2022) https://doi.org/10.53347/rID-4959 • CC by-nc-sa 3.0 (modified)
Rupture of an
echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis. The hepatic cyst shows hyperattenuating rim on caudal level.
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Water-lily
sign (hydatid cyst) • Hepatic hydatid cyst - ultrasound water lily sign - Ganzer Fall bei Radiopaedia
Peer, S. Hepatic hydatid cyst - ultrasound water lily sign. Case study, Radiopaedia.org. (accessed on 31 Oct 2022) https://doi.org/10.53347/rID-38039 • CC by-nc-sa 3.0 (modified)
Improved
characterisation of cystic liver echinococcosis by MRI. A large (7-cm) well-demarcated ovoid-shaped lesion, with thin regular wall (thin arrows) was detected in the right liver lobe; the mass was mostly echogenic (*) at the periphery with central serpiginous hypo-anechoic component.
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Improved
characterisation of cystic liver echinococcosis by MRI. Precontrast CT confirmed a large ovoid-shaped mass in the right liver lobe, with thin regular hypoattenuating wall (thin arrows), peripheral solid (25-35 Hounsfield units - HU) portions (*) and central hypodensity (15-18 HU, +), without any calcification.
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Improved
characterisation of cystic liver echinococcosis by MRI. In portal-venous (d,e) and equilibrium (f) phases the ovoid mass in the right liver lobe did not enhance. Note thin regular peripheral wall (thin arrows), central hypoattenuation (+), peripheral solid-attenuation components (*).
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Improved
characterisation of cystic liver echinococcosis by MRI. T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous "canalicular" appearance (arrows) of alternating signal intensities.
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Improved
characterisation of cystic liver echinococcosis by MRI. T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous "canalicular" appearance (arrows) of alternating signal intensities.
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Cystic liver
lesions: a pictorial review. cyst echinococcosis 2, in a 50-year-old male. a Axial non-enhanced computed tomography shows a heterogeneous mass with a cystic part (arrow) and calcification of the wall (arrowhead). b On axial computed tomography on portal venous phase no enhancement of the cystic component is observed. c The cystic part and the differentiation between the daughter (arrow) and the mother (star) cysts are better evaluated on axial T2-weighted magnetic resonance imaging. d Coronal 3D magnetic resonance cholangiopancreatography excludes biliary fistula from the possible diagnosis
insightsimaging.springeropen.com • CC-by-4.0
Cystic liver
lesions: a pictorial review. Complicated hydatid cyst in a 50-year-old female. Imaging displays a cyst very close to the biliary tract with lobulated margins, showing a loss of intralesional pressure, most probably resulting from a complication of the biliary connection (not found on magnetic resonance cholangiopancreatography). a Axial T2-weighted magnetic resonance imaging. b Coronal 3D magnetic resonance cholangiopancreatography. c and d Axial T1-fat-sat-weighted imaging without and with contrast on portal venous phase
insightsimaging.springeropen.com • CC-by-4.0
A strange
case of pulmonary embolism. A large multiloculated partly calcified echinococcal cyst is seen in III-IV hepatic segment; the lesion is continuity with left hepatic vein, which is not detectable, being filled with hypodense material.
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Hepatic
hydatid infection • Ruptured hepatic hydatid cyst with subcapsular collection - Ganzer Fall bei Radiopaedia
Niknejad, M. Ruptured hepatic hydatid cyst with subcapsular collection. Case study, Radiopaedia.org. (accessed on 31 Oct 2022) https://doi.org/10.53347/rID-85424 • CC by-nc-sa 3.0 (modified)
Hepatic
hydatid infection • Spontaneous intraperitoneal rupture of hepatic hydatid cyst - Ganzer Fall bei Radiopaedia
Ibrahim, D. Spontaneous intraperitoneal rupture of hepatic hydatid cyst. Case study, Radiopaedia.org. (accessed on 31 Oct 2022) https://doi.org/10.53347/rID-94439 • CC by-nc-sa 3.0 (modified)
Complicated
hepatic hydatid disease.. Abdominal ultrasound showing a type 2 hydatid cyst. It is round, measures 21cm, and has sharply defined margins. Note that the daugther cyst is arranged on the perphery of the main cyst.
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Complicated
hepatic hydatid disease.. Mother cysts show more radiological density than daughter cysts. Fluid collection in the subphrenic space and invasion of the abdominal wall is also seen.
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Complicated
hepatic hydatid disease.. Large HC with structural deformity, disruption and presence of a fluid collection in the subphrenic space adjacent to the ruptured HC.
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Complications
of hepatic echinococcosis: multimodality imaging approach. A 21-year-old man with hepatic hydatid cyst. Axial contrast-enhanced CT image on portal venous phase shows hepatic hydatid cyst (arrow) causing compression and dilatation of adjacent intrahepatic bile ducts (arrowhead)
insightsimaging.springeropen.com • CC-by-4.0
Complications
of hepatic echinococcosis: multimodality imaging approach. A 72-year-old woman with hydatid cyst and portal vein thrombosis. Oblique reformatted CT image on portal venous phase shows a large hepatic hydatid cyst adjacent to the left branch of portal vein (arrowhead) and partial portal vein thrombosis (arrows)
insightsimaging.springeropen.com • CC-by-4.0
Rupture of an
echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis. The left hepatic lobe contains an inhomogeneous cyst (CE4). A large splenic cyst (CE1) is just below visible.
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Rupture of an
echinococcal cyst within the colon in a case of disseminated abdominal cystic echinococcosis. Uniloculated hepatic cyst and large splenic cyst with irregular border and hyperattenuating septum, consistent for contained rupture.
www.eurorad.org • CC by-nc-sa-4.0
Improved
characterisation of cystic liver echinococcosis by MRI. On T1-weighted imaging the peripheral pseudo-solid components (*) were nearly isointense compared to liver, the central matrix (+) had very low fluid-like signal with serpiginous "canalicular" appearance (arrows).
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Hepatic hydatid disease is a parasitic zoonosis caused by the Echinococcus tapeworm. In the liver, two agents are recognized as causing disease in humans:

  • Echinococcus granulosus
  • Echinococcus multilocularis

For a general discussion, and links to other system-specific manifestations, please refer to the article on hydatid disease. For a more specific discussion related to the invasive pattern attributed to the E. multilocularis infection,  please refer to the article on alveolar echinococcosis.

Pathology

The parasite E. granulosus is endemic in North America and Australia and is commonly seen in the liver. It typically forms a spherical, fibrous-rimmed cyst with little, if any, surrounding host reaction. Classically it has a large parent cyst within which numerous peripheral daughter cysts are present. Satellite daughter cysts (outside the parent cyst) are seen frequently (~16% cases).
There are two forms of E. granulosus:

  • pastoral: the most common form; the domestic dog is the main host 
  • sylvatic: wolf or dog is the main host

The E. multilocularis definitive host (adult parasite) is the red fox (Vulpes vulpes) (sometimes cats and dogs as well), with humans serving as the accidental intermediate host. It is widely distributed throughout the Northern hemisphere.

Radiographic features

This article will discuss the most common presentation of the hepatic hydatid disease, characterized by well-defined encapsulated cystic or multicystic masses related to E. granulosus. For a specific discussion on the less common invasive form, caused by E. multilocularis, please refer to the article on alveolar echinococcosis.

Plain radiograph

May show a curvilinear or ring calcific shadow overlying the liver due to calcification of the pericyst.

Ultrasound

Septated cyst with "daughter" cysts and echogenic material between the cysts. Appearances can vary. May show a double echogenic shadow due to the pericyst. The stage of the cyst may be classified on ultrasound, see: World Health Organization 2001 classification of hepatic hydatid cysts.

CT

Fluid density cyst, with frequent peripheral focal areas of calcification, usually indicates no active infection if completely circumferential. Septa and daughter cysts may be visualized. The water-lily sign indicates a cyst with a floating, undulating membrane, caused by a detached endocyst. May also show hyperdense internal septa within a cyst showing a spoke wheel pattern. The fluid is of variable attenuation, depending on the amount of proteinaceous debris. May show dilated intrahepatic bile ducts due to compression or rupture of the cyst into bile ducts.

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): the walls and septa enhance

Treatment and prognosis

Complications

Rupture into the:

  • biliary tree
  • peritoneal space (if exophytic)
  • bloodstream
  • lung

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Echinococcus Leber:
hepatozelluläres
Karzinom
Wikipedia • CC BY 3.0
Echinokokkose
 
www.eurorad.org • CC by-nc-sa-4.0
Lebermetastasen
 
Wikipedia • CC BY 3.0
Wasserlilien-Zeichen
 
www.eurorad.org • CC by-nc-sa-4.0
hepatic
echinococcosis alveolaris
insightsimaging.springeropen.com • CC-by-4.0
Echinococcus
multilocularis
insightsimaging.springeropen.com • CC-by-4.0
Echinokokkose
der Milz
bmcsurg.biomedcentral.com • CC-by-4.0
chronic
hydatid cysto-hepato-bronchial fistula
www.eurorad.org • CC by-nc-sa-4.0
Ruptur einer
Echinokokkuszyste der Leber in die Gallenwege
bmcsurg.biomedcentral.com • CC-by-4.0