Presentation
Increasing abdominal pain and fever
Patient Data
Very large multilobulated, septated, calcified cystic left splenic lesion is again seen consistent with the known hydatid cyst measuring 21.5 x 14.6 x 21.8 cm, displacing the stomach to the right, and the left kidney, splenic flexure and pancreatic tail inferiorly. It is predominantly filled with low density fluid, but also contains a moderate volume of gas laterally. No free intraperitoneal gas is seen. A large volume of free intraperitoneal fluid is seen. The liver is surrounded by free fluid and has an extremely nodular surface with scalloping of the capsule. Hypodense lesions in segment 6 and 8 are stable. Tiny segment 5 calcific granuloma. Stable hyperdense right renal cyst. The remainder of the intra-abdominal and pelvic organs are unremarkable.
Large left pleural effusion.
Conclusion
- Very large splenic hydatid cyst with free intraperitoneal fluid consistent with cyst rupture. New intra-cystic gas of uncertain source and may represent secondary infection.
- Stable liver cystic lesions.
Case Discussion
The scalloped nature of the liver is typical for the thick fluid released from the ruptured hydatid cyst.
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