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Case of the Month 07/08

This 35 year old male originally from Yemen was sent for further testing after a subtle abnormality was seen in on a screening chest xray. (Dr. Reagan has an amazing eye for these things.) Question 1: Can you see the subtle abnormality? (Hint – it is below the diaphragm)

Answer 1

Question 2: Which imaging studies might you order next?

View answer

The differential based on the CXR results included echinococcal cyst and large gall stone. The patient had an ultrasound and then an abdominal CT (see below.)

The ultrasound showed multiple hepatic cystic masses. The CT was read as “calcified complex hepatic cystic masses with internal enhancement highly suspicious for an infectious process, such as echinococcus.” After his serum echinococcal Antibody returned highly positive, the patient underwent 4 weeks of treatment with albendazole. This was done less so to treat the cysts as it was to decrease fluid infectivity in case of rupture during surgery. When the cysts were unchanged in size on a repeat CT, he underwent surgery to remove the cysts. In spite of intraoperative rupture of one of them, the patient recovered nicely and was discharged from the hospital 4 days post-operatively.