Hepatic hydatid cyst - intrathoracic rupture
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There is a cystic lesion of irregular and lobulated contours of the hepatic dome, centered on the segments VII/VIII, containing air-bubbles with peripheral calcification. Evidence of transdiaphragmatic/transpleural fistulous track (well-visualized on reconstructed images) extending from the cystic lesion of the liver to the anterior segment of the lower lobe with associated lung consolidation (secondary pneumonia). Reactive enlargement of the right paratracheal lymph nodes is noted. There is an extension of the lesion beyond the calcific rim, suggesting rupture into adjacent liver with presumably some degree of biliary necrosis and faint bile duct dilatation.
CT features of a hepatic hydatid cyst ruptured into the anterior segment of the right lower lobe.
Hepatic hydatid cyst with a calcified wall as in this case is classified CE 5 according to the WHO classification of hepatic hydatid cysts, type V according to Gharbi classification, or type IV according to the classification based on the morphology of the cyst (see: hydatid disease).
Intra-thoracic rupture of hepatic hydatid cysts is a rare complication. The cystic rupture may be due to trauma or increase pressure within the growing cyst. It may be asymptomatic or present as an anaphylactic reaction, depending on the location of the cyst. The cysts located in the dome of the liver (as in this case) need wedge resection and cystectomy of the primary lesion if recurrence an albendazole treatment occurs.