The top differential diagnosi is for hydatid cyst
-Biliary cystadenocarcinoma (Rare, multiseptated) -Hepatic pyogenic abscess ("Cluster of grapes") -"Cystic" metastases (Metastatic sarcoma or ovarian carcinoma) -Hemorrhagic or infected cyst (Complex cystic, heterogeneous mass,with septations, fluid levels, and mural nodularity)
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'.