Hydatid cysts in the liver

A 67-year-old Taiwanese woman with multilocular hydatid cysts of the liver presented with a 5-month history of intermittent right upper abdominal discomfort. Abdominal ultrasonography and computed tomography showed multiple cysts in both lobes of the liver. Subsequent selective celiac angiography revealed an avascular space-occupying lesion in the right lobe. She underwent a radical excision of the cyst by total closed (without opening the wall) cystopericystectomy over segments 4, 5 and 6. Histologic study of the lesions showed three structural components: 1) an outer acellular laminated membrane, 2) a thin nucleated germinal membrane and 3) several protoscolices with Echinococcus granulosus suckers. The patient has been well for 5 years since her discharge. Although hydatid cysts of the liver are extremely rare in Taiwan, they may cause life-threatening complications and mortality. Making a preoperative diagnosis is important and is only possible if this rare disease is kept in mind.