Clinical Images
Huge echinococcal cyst
Antonio L. Aguilar Shea1, Cristina Gallardo Mayo2
1Family Practice. Centro de Salud Puerta de Madrid. Atención Primaria. Madrid. Spain
2Anestesiology and Reanimation, Hospital Infanta Leonor, Madrid, Spain

Article ID: 100031Z09AS2017

Address correspondence to:
Dr. Antonio L. Aguilar Shea
MD, PhD, Family Practice, E.A.P. Puerta de Madrid,
Avda. del Ejército 61, 28802 Alcalá de Henares (Madrid)

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How to cite this article
Shea ALA, Mayo CG. Huge echinococcal cyst. J Case Rep Images Med 2017;3:9–10.


A 71-year-old male who lives in an urban area presented with a progressive increase of his abdominal volume with diastasis rectus abdominis. Computed tomography (CT) scan revealed a 15×8 cm huge cyst in the VI liver segment that infiltrated and dissected the anterior epigastric wall with muscle affectation, these findings were considered compatible with echinococcal disease (Figure 1). On the patient’s history review it was discovered that in 2005 he had two calcified lesions in the right liver lobule and one in the caudate lobe described as inactive echinococcosis. These calcified lesions were unchanged in CT scans done in 2013 to 2016 (Figure 1). Patient was admitted for surgery due to the risk of rupture, histopathology report confirmed the echinococcal disease. The patient did not have a dog and was not in close contact with any herd animals, so an unknown reinfection or reactivation was suspected. Echinococcal disease is caused by infection with the metacestode stage of the tapeworm Echinococcus.

E. granulosus infection is the most frequent and typically affects the liver creating cysts. Symptoms are unusual unless the cysts become large, were the main complication is rupture, which can cause an anaphylactic reaction that could lead to death [1][2]. The diagnosis is usually done by ultrasound or computed tomography scan management options for echinococcal cysts include surgery, percutaneous management, drug therapy and observation. Surgery is the treatment of choice for management of complicated cysts, including those over 10 cm like in our case [3][4]. A review in literature revealed similar cases of giant liver echinococcal cysts that were managed surgically with a good outcome [5][6][7] .

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Figure 1: Computed tomography scan revealing echinococcal cyst change from 2013 to 2016.


The case highlights the importance that high index suspicion for echinococcal disease progression should be maintained in patients with previous known hydatid liver cyst. When increased in size, liver echinococcal cysts treatment of choice is surgery.

Keywords: Echinococcal cyst, Echinococcus granulosus, Hydatid disease, Liver

  1. Mihmanli M, Idiz UO, Kaya C, et al. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016 Oct 8;8(28):1169–81.   [CrossRef]   [Pubmed]    Back to citation no. 1
  2. Pakala T, Molina M, Wu GY. Hepatic echinococcal cysts: A review. J Clin Transl Hepatol 2016 Mar 28;4(1):39–46.   [CrossRef]   [Pubmed]    Back to citation no. 2
  3. Barosa R, Pinto J, Caldeira A, Pereira E. Modern role of clinical ultrasound in liver abscess and echinococcosis. J Med Ultrason (2001). 2016 Dec 8.   [CrossRef]   [Pubmed]    Back to citation no. 3
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  5. Sahin DA, Kusaslan R, Sahin O, Dilek ON. Huge hydatid cysts that arise from the liver, growing exophytically. Can J Surg 2007 Aug;50(4):301–3.   [Pubmed]    Back to citation no. 5
  6. Pavlidis ET, Symeonidis N, Psarras K, Pavlidis TE. Huge echinococcal cyst of the liver managed by hepatectomy: Report of two cases. Int J Surg Case Rep 2017;31:79–82.   [CrossRef]   [Pubmed]    Back to citation no. 6
  7. Ettorre GM, Vennarecci G, Santoro R, et al. Giant hydatid cyst of the liver with a retroperitoneal growth: A case report. J Med Case Rep 2012 Sep 13;6:298.   [CrossRef]   [Pubmed]    Back to citation no. 7

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Author Contributions
Antonio L. Aguilar Shea – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Cristina Gallardo Mayo – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
Conflict of interest
Authors declare no conflict of interest.
© 2017 Antonio L. Aguilar Shea et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.