Marble in the stomach and incidental hepatic hydatid cyst

Case contributed by Dr Hidayatullah Hamidi

Presentation

Blunt abdominal trauma one week ago. Mild abdominal pain thereafter.

Patient Data

Age: 15 years
Gender: Male

A round opaque structure in the right iliac fossa.

No pneumoperitoneum.

  • series 1: A heterogenous relatively echogenic round lesion in the liver.
  • series 2: A hypoechoic lesion with internal thick membrane in the liver.
  • series 3: An arch-like echogenic structure with posterior shadowing in the gastric lumen.

Keeping with context of trauma, CT exam was suggested.

CT exam obtained after one day

CT

The round opacity is now seen more cranial to the previous x-ray.

A multi-layered cystic lesion with internal crumpled membrane in segment II, III and 4B of the liver measuring 13.3 x 7 x 5.8 cm.
Another lesion with peripheral calcification and thick contents in segment II of liver measuring 3.8 x 5 3.6 cm. No enhancement in any phase.
An oval shape dense structure is noted in the lumen of the stomach at antral region.
Mild pelvic ascites is noted.
Gall bladder as well as intra and extra hepatic biliary channels are normal.

Case Discussion

The features are of incidental finding of hepatic hydatid cyst. No trauma related abnormality of the liver is seen. As there is mild pelvic ascites, the possibility of intraperitoneal rupture of the larger hepatic cystic lesion needs to be taken in consideration.

The history was remarkable for an ingested glass marble about eight years ago. which is still present in stomach.

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