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The imaging appearances of hydatid disease at some unusual sites

¹ Department of Diagnostic Radiology and Imaging, Al-Sabah Hospital
² Department of Diagnostic Radiology and Imaging, Al-Adan Hospital, Kuwait

View larger version (77K): [in a new window]   Figure 1. (a) 27-year-old male with chest pain and dyspnoea. Chest radiograph shows well defined bilateral perihilar masses. The lung fields are clear. (b) Contrast enhanced CT at the level of the ascending aorta shows two adjacent large Type I hydatid cysts in the anterior mediastinum.

View larger version (132K): [in a new window]   Figure 2. Posteroanterior and left oblique chest radiograph showing a calcified (Type III) hydatid cyst in the wall of the left ventricle in an asymptomatic 38-year-old male.

View larger version (127K): [in a new window]   Figure 3. Contrast enhanced CT of the abdomen at the level of the left kidney. Two large hydatid cysts of equal size in the right lobe of the liver in a 40-year-old male.

View larger version (128K): [in a new window]   Figure 4. Contrast enhanced CT of the upper abdomen in a 19-year-old patient, showing a stage II hypermature cyst, with loss of peripheral definition and interior clarity, and daughter cysts filling the centre. There is evidence of communicating rupture, with biliary dilatation "upstream" (arrow). Small amount of ascites is present (arrowhead).

View larger version (106K): [in a new window]   Figure 5. Contrast enhanced CT of the upper abdomen in a young patient with abdominal discomfort and progressive abdominal distension. A giant isolated Type I splenic cyst displaces bowel to the right.

View larger version (121K): [in a new window]   Figure 6. Non-enhanced CT of the upper abdomen showing an isolated Type II hypermature cyst in the spleen, with daughter cysts (arrowhead) and matrix with a density of 34 HU (arrow).

View larger version (128K): [in a new window]   Figure 7. Plain abdominal radiograph in a 45-year-old physician with an isolated Type II/III cyst in the spleen. He presented with an acute abdomen and anaphylactic shock due to direct rupture of the cyst into the peritoneal cavity. A large number of daughter cysts were removed at laparotomy. 3 years later, an abdominal radiograph shows extensive calcification of the residual disseminated daughter cysts.

View larger version (124K): [in a new window]   Figure 8. Contrast enhanced CT of the upper abdomen, showing a solitary calcified hydatid cyst in the lesser sac. The patient presented with abdominal pain and a palpable epigastric mass.

View larger version (154K): [in a new window]   Figure 9. Contrast enhanced CT of the abdomen, showing hydatid disease involving the body and tail of the pancreas (arrow) in a 35-year-old male. Note daughter cysts (arrowhead).

View larger version (154K): [in a new window]   Figure 10. Non-enhanced CT of the abdomen in a 29-year-old patient, showing a large Type II solitary retroperitoneal hydatid cyst displacing bowel anteriorly. The left kidney was displaced inferiorly and malrotated.

View larger version (74K): [in a new window]   Figure 11. (a) Plain abdominal radiograph of a 38-year-old patient with infertility and ejaculatory difficulty, showing a calcified lesion in the right side of the pelvis. (b) CT shows the calcified lesion to be in the region of the right seminal vesicle. The lesion was removed and pathological examination confirmed hydatid disease of the seminal vesicle.

View larger version (66K): [in a new window]   Figure 12. (a) An expanding cystic lesion in the left sixth rib of a 31-year-old patient with chest pain and left-sided chest swelling. (b) CT showed an expanding lesion with a dense matrix of 61 HU. The rib was resected and hydatid disease was confirmed.

View larger version (74K): [in a new window]   Figure 13. Plain radiograph of the right femur in a 60-year-old man, showing extensive osteolytic destruction with cortical thinning, pathological fractures and soft tissue extension. Metastatic disease or myeloma was the initial diagnosis. Hydatid disease was confirmed at surgery.

View larger version (173K): [in a new window]   Figure 14. Contrast enhanced axial CT of the left shoulder in a 32-year-old male with a painless swelling for 2 years, showing multiple cysts with peripheral enhancement.

View larger version (163K): [in a new window]   Figure 15. Contrast enhanced axial CT of a 23-year-old male with painless swelling of the right thigh. Multiple hydatid cysts with daughter cysts producing a multiloculated appearance in the rectus femoris and vastus lateralis muscles.