SummaryHydatid disease is a parasitic infection caused by Echinococcus granulosus and Echinococcus multilocularis. It is common in endemic regions and can demonstrate a variety of imaging features that differ according to the affected organ and the stage of the disease. Liver and lungs are the most commonly affected organs. The classic features of hepatic hydatid disease are well known. However, diagnosing hydatid disease at unusual locations may be challenging because of myriad imaging features in each of these locations. Knowledge of the imaging spectrum in systemic hydatidoses in various organs is very valuable in improving the accuracy of radiological interpretation. The purpose of this article is to review the imaging features of hydatid disease at its varied locations.
A three-day-old female child with history of a full term, normal delivery presented to us with abdominal distension and lower limb swelling. The pregnancy though uncomplicated was poorly followed and no antenatal ultrasonograms were available. The delivery was conducted in the hospital affiliated to our institute. The child had passed meconium and was micturating normally since birth. On physical examination, the child was of appropriate weight for gestational age and had no dysmorphic features.On clinical examination, the child had a palpable mass in the lower central abdomen. The superior margins of the mass were appreciated. Both lower limbs had mild pitting pedal oedema. The child was referred to Department of Radio-diagnosis for evaluation of the abdominal mass. A plain radiograph of the abdomen was initially obtained. Plain radiography of the abdomen showed homogenous soft tissue opacity in the suprapubic region of the abdomen that was causing peripheral displacement of the gas filled bowel loops [Table/ Fig-1] Ultrasound of the abdomen was carried out in the Philips iU22 machine using a paediatric sector probe (5-8 MHz). On ultrasound examination, there was a cystic structure in the lower abdomen and pelvis which showed fluid-debris level. This mass was causing displacement of the urinary bladder anteriorly. Uterus with endometrial collection was seen at the cranial end of the above structure and appeared to be continuous with it. Bowel loops were being displaced peripherally. There was mild dilation of bilateral renal pelvicalyceal systems. Rest of the intra-abdominal Magnetic Resonance Imaging (MRI) of the abdomen and pelvis was done in the Siemens Avanto 1.5 Tesla MRI machine to confirm the above diagnosis. MRI confirmed the findings of ultrasound. There was accumulation of fluid intensity T1 hypointense, T2 hyperintense contents within the vagina and endometrial cavity. The resulting distended vagina was extending above the level of umbilicus. There was no obvious narrowing of distal vagina on magnetic resonance imaging. Bilateral hydronephrosis and pitting lower limb oedema was likely secondary to mass effect from the above structure [Table/Fig -3,4].
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