Hepatic alveolar echinococcosis
Large right hepatic mass of mixed attenuation with some cystic parts and perhaps solid components as well. There is an element of chronicity as evidenced by the hepatic parenchymal atrophy and compression (possible invasion) of vascular structures. The appearance of "cysts within cysts", most visible at the superior portion of the mass, is suggestive of hepatic echinococcosis. Because of the infiltrating appearance of the mass, one should consider hepatic alveolar echinococcosis, a rarer but more aggressive form of hepatic hydatid infection caused by Echinococcus multilocularis. It is unclear if there had been a recent rupture of part of the mass to explain more acute symptoms.
Complete blood count showed no leukocytosis or eosinophilia. Liver function tests and enzymes were normal.
Differential diagnosis in this case included:
Upon further questioning by the clinical team, the patient who lived in a North African country was presently on vacation. Her travel insurance opted to repatriate her and therefore diagnostic confirmation was unavailable to us.