Hepatic dome hydatid cyst rupture

A large complex right juxtaphrenic mass lesion with an hourglass configuration, the inferior portion located in the subcapsular aspect of hepatic segment 8 with pressure effect on the hepatic veins/ IVC confluence, the bulk of the lesion is protruding above the diaphragmatic plane (difficult to ascertain whether it is pleural or peripheral pulmonary). The lesion shows sparse wall calcifications, smaller round fluid density regions at its inferomedial aspect (likely representing daughter cysts), and predominant peripheral irregular enhancement. Few reactive anterior diaphragmatic lymph nodes. The superior component of the mass draped over the hepatic dome from anterior to posterior with pressure effect manifested as: 

• shifts the heart leftward and exerts mass effect mainly on the right atrium (intimately related to the pericardium, no thickening or abnormal enhancement), physiologic amount of pericardiac fluid depicted

• narrows the hepatic/supra-hepatic IVC and splay the right inferior pulmonary vein along its posterior aspect, with no thrombosis or invasion

• basal subsegmental lung compressive atelectasis with scattered foci of calcification, patent albeit narrowed bronchioles within, a mild amount of pleural effusion extending along the oblique fissure, no empyema, confluent thick-walled cysts seen at the right lateral basal segment with coarse calcification and cylindrical bronchiectasis in its vicinity (? Residual cavity related to hydatid cyst resection)

Liver: otherwise shows mottled pattern of parenchymal enhancement in the arterial and portal phases with the decreased enhancement of the liver periphery, on the delayed phase the enhancement becomes more uniform reflecting perfusion abnormality as a result of hepatic venous congestion (aforementioned IVC compression resulting in a symptomatic variant of Budd-Chiari syndrome).