We previously posted a diagnostic challenge:
12 year old female with an abdominal/liver mass consisting of lots of little cysts.
Did you figure it out?
If you weren't sure, here are some micro images should help and that prove our diagnosis!
That's right, it's a hydatid cyst. These are infections by the tissue-infectious Cestode or tape worm Echinococcus. [The CDC has a fantastic set of websites on parasitic infections, including lots of detailed information on organisms and life cycles]. Echinococcus is usually transmitted by dogs to humans via fecal-oral contamination. The worms tend to set up shop in the liver, creating a cystic mass that gets filled with daughter cysts containing parasite larvae (seen in the gross photos, linked above). Patients present with vague abdominal pain and the treatment is surgical resection of the mass.
For more information about some of the many, many parasites in the world, I strongly recommend reading the book Parasite Rex.
Brief follow-up: my colleague and friend from home correctly asked, "Hey, if this thing ruptured in the patient, did she get really sick?" He, being a skill physician, asked this in a more medical manner and wisely so because hydatid cysts CAN rupture and result in a severe allergic reaction (anaphylaxis) secondary to a big parasite burden. But only sometimes. This little girl DID have an intrabdominal rupture of the cyst (and the surgeons and I agree it did not smell nice), but was fine! She is now being discharged and is a happy little camper, although she is on 6 months of anti-parasitic drugs. I'll try to post an intra-operative picture soon.
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