Hepatic hydatid cyst
Right hypochondrial pain.
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Hepatomegaly with hydatid cyst showing crumpled membranes
Hydatid cysts may show a variety of appearences. The cyst wall is three layered of which detachment of the endocyst from the pericyst leads to the appearence of a well defined fluid collection with a localized split in the wall and floating membranes within the cavity.
Complete detachment of the membranes inside the cyst has been referred to as the US water lily sign as is seen with this case.
Detachment of the endocyst from the pericyst is probably related to decreasing intracystic pressure, degeneration, host response, trauma, or response to therapy.
US is the most sensitive modality for the detection of membranes, septa, and hydatid sand within the cyst.