Calcified hydatid cyst of spleen

Case contributed by Dr Ammar Haouimi

Presentation

Incidental findings in a patient with recurrent urinary tract infections.

Patient Data

Age: 55 years
Gender: Female

The CT scan demonstrates:

  • diffuse hepatic steatosis
    • mild hepatomegaly
    • diffuse hypoattenuation of the liver
    • liver-spleen differential attenuation on contrast-enhanced CT: liver (23 HU) - spleen (73 HU) = -50 HU). Hepatic steatosis from -20 to less than -43 HU
  • calcified splenic mass: the peripheral calcification of the pericyst and internal serpentine calcification of the membranes (endocyst)
  • Small right kidney with cortical thinning/scars and mild dilatation with distortion of the calyces (Chronic pyelonephritis)

Case Discussion

CT feature of a calcified splenic mass probably hydatid cyst with diffuse hepatic steatosis (incidental findings) in a patient with chronic pyelonephritis.

Splenic hydatid infection is considered as a rare form of hydatid disease, and isolated splenic involvement is even less common. usually asymptomatic.

The spleen is involved in three situations:

  • systemic dissemination
  • intraperitoneal spread from a ruptured hepatic hydatid cyst 
  • retrograde spread from the liver to the spleen via the hepatic portal and splenic veins in portal hypertension

The differential diagnosis for splenic hydatid cysts includes other splenic cystic lesions:

  • splenic epidermoid cysts
  • splenic pseudocysts
  • splenic abscesses
  • splenic hematomas
  • cystic neoplasms of the spleen 
  • intrasplenic pancreatic pseudocyst 

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