This week's impressive case was donated by Drs. Ashley Zeoli, Nico Herrera, Luke Pryke, and Paul Blair. The patient is a young man with no significant medical history who presented with right upper quadrant abdominal pain. The pain had been present for several years, but recently worsened to the point that he sought medical care. He is originally from India.
Here was the CT from admission which shows a large, complex cyst in the liver:
Here is a video of the gross findings:
The following object was identified in the cyst fluid:
5 comments:
Hydatid cyst filled with daughter sand likely Echinococcus granulosus
The liver cyst history leads me to think that this is a liver fluke. The last picture of a somewhat heart shaped object makes me believe that it is possibly a Fasciola hepatica with a retracted cephalic cone and prominent shoulders.
Very impressive case, we don’t get to see enough in the regular parasitology labs.
Florida Fan
Hydatid cyst resulting from a Echinococcus granulosus infection
Impressive indeed!
The fact that this patient has been running around for years with this slowly growing liver cyst points towards Echinococcus sp. From the video we see that the cyst contains clear liquid, which again gives an indication towards Echinococcus.
Finally this is confirmed by the protoscolex that is visible on that last picture. The invaginated scolex seems armed with hooklets and we get an impression from the suction discs. The fact that this is a non-sterile cyst makes me lean towards hydatic cyst of E. granulosus, but I wouldn't dare say that with certainty.
Superb case! Thanks!
I see, upon higher magnification the hooklets of the invaginated protoscolex are very apparent.
Florida Fan
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