Presentation
Diabetic patient with chronic epigastric pain. Total white blood count >16 k/μL and hematocrit of Ht of 30%.
Patient Data
In the left lobe of the liver, a well-defined cystic mass with a “floating membrane” within the cavity. The “floating membrane” represents the complete detachment of the endocyst-laminated membrane (red color) from the pericyst (green color) and is referred to as the “Water-Lily” sign.
This ultrasonographic sign is pathognomonic for Echinococcosis hydatid cyst in the transitional stage (WHO CE3). Note the multiple echogenic foci (yellow arrows) due to hydatid 'sand'.
Case Discussion
Echinococcus granulosus is the most common cause of hydatid disease.
This ultrasonographic sign is pathognomonic for Echinococcus hydatid cyst in the transitional stage (WHO CE3). It is necessary to recognize and diagnose the exact stage of echinococcus cyst, because the PAIR (Puncture, Aspiration, Injection, Re-aspiration), a minimally invasive therapeutic option is feasible in types CE1, CE2 and CE3 of the WHO classification of Echinococcus cysts.
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