Presentation
Patient with hepatosplenomegaly with incidental upper pole splenic cyst on ultrasonography.
Patient Data
A sizable medial splenic cystic lesion is noted. It is well circumscribed and surrounded by splenic parenchyma, occupying the upper pole of the spleen, mildly exophytic from its medial surface stretching overlying splenic tissues and capsule. It is measuring 13 x 11.5 x 12.7 cm in AP, SS and CC dimensions respectively. It showed multiple coarse mural calcifications with no appreciable post contrast enhancement. It is of high-density homogenous fluid content. Clear surrounding splenic parenchyma. No other splenic lesion identified.
Three hepatic focal lesions are noted at segments III (1.3 cm), segment II (1 cm) and segment IVB (1.8 x 2.7 cm). All of them showed peripheral nodular enhancement at porto-venous phase with homogenous fill-in at delayed phase, mostly multiple hepatic hemangiomas.
The spleen is markedly enlarged reaching 24 cm at coronal dimension with normal tissue characters. Dilated splenic (15 mm) and portal (17 mm) veins with good opacification and patent lumen. No evidence of arterioportal shunting or portal vein thrombosis.
The liver shows moderate enlargement of the right lobe measuring 20 cm at CC dimension in MCL reaching the right iliac crest. Left hepatic lobe and caudate lobe are not enlarged. This is associated with dilated hepatic veins, suggestive of passive congestive hepatosplenomegaly.
Right renal middle calyceal stone measuring 5 x 6 mm with no back pressure changes.
Case Discussion
Splenic hydatid infection is a rare form of hydatid disease, with the same characteristics of various appearances of a hydatid cyst. This case shows one of the forms of a suspected hydatid cyst - a solitary cyst with fluid content and coarse mural calcifications. These features are probably of a CE 5 splenic hydatid cyst. Other differential diagnoses include splenic epidermoid, chronic hematoma and splenic pseudocyst.
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