Presentation
Chronic non-specific abdominal pain.
Patient Data
A 25 mm lesion with coarse peripheral calcification in the right liver lobe suggests a calcified hydatid cyst.
A 35 mm cystic lesion is seen adjacent to the gallbladder, and an 18 mm small one in the right subhepatic region. In addition, several thick-walled cystic lesions are seen in the mesenteric root, para-cecal region, and pelvis around the uterus fundus and ovaries. The largest one measured 65 mm in diameter.
Two shapeless, ill-defined hepatic lesions are seen in the vicinity of the falciform ligament and lateral to the gallbladder, which become isodense with surrounding parenchyma on delayed images.
Case Discussion
Primary peritoneal hydatidosis is rare, and secondary peritoneal hydatidosis is almost always caused by hepatic hydatid disease. It is related to seeding from spontaneous rupture of a hepatic cyst into the peritoneum or spillage of cyst fluid during surgery. In both instances, depending on the patient's immune response, this sudden release of hydatid antigens into the peritoneal cavity can result in anaphylaxis. If this does not occur and viable organisms are present, then multiple cysts can develop.
Regarding the peripherally calcified hepatic lesion in this patient that is highly suggestive of a calcified hydatid cyst, the scattered abdominopelvic peritoneal cystic lesions are most consistent with the peritoneal hydatidosis and confirmed with serologic evaluation.
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