Case 375:   Echinococcosis, alveolar

Diagnostic Category:

Clinical Presentation:

55 year-old man from Switzerland with right upper quadrant pain, fever, and unintentional weight loss for 2 months.

US: Spongiform lesion; avascular on CEUS with irregular margins

Imaging Findings:

Spongiform large poorly defined echogenic mass in the right lobe without increased acoustic transmission and without noticeable Doppler flow.

Contrast enhanced ultrasound reveals very irregular, but well defined avascular mass with hypervascular reaction of adjacent hepatic parenchyma. Ultrasound guided biopsy of mass revealed granulomata and innumerable scolices from active disease of alveolar echinococcosis.

Non-enhancement of the lesion, reactive hyperemia and good demarcation on the portal venous and later vascular phases are typical for parasitic diseases.

Courtesy Dr. Gerd Stuckmann, Institute for Radiology and Nuclear Medicine, Kantonsspital Winterthur,  Switzerland.