SHM Converge Scientific Abstract ePoster Gallery-The Unexpected Intruder: A Challenging Case of Giant Hepatic Echinococcosis

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A 17-year-old male with no significant past medical history presented with several months of generalized weakness, malaise, and low-grade fevers after recent travel to Europe and drinking tap water while abroad. On admission he was afebrile but had leukocytosis, thrombocytosis, and eosinophilia. Imaging revealed a very large 19.7 x 16.9 x 24 cm rim-enhancing fluid collection occupying most of the right hepatic lobe, initially thought to be a hepatic abscess.<br /><br />After CT-guided drainage, ultrasound demonstrated the water lily sign, raising strong suspicion for hydatid disease. Fluid pathology showed protoscolices consistent with a cestode, and Echinococcus IgG was elevated, confirming hepatic echinococcosis. He was started on albendazole and later transferred for higher-level care. Surgery deferred resection initially, and interventional radiology performed the PAIR procedure twice with infusion of hypertonic saline. Because of concern for spillage and tract formation, the drain was kept in place for at least 6 weeks.<br /><br />He was discharged on albendazole and praziquantel with infectious disease follow-up. Despite completing 6 months of therapy, he continued to have intermittent fevers, and follow-up MRI showed a persistent large 18 cm hepatic cyst. He remains on long-term albendazole and is being evaluated by hepatobiliary surgery for possible operative management.<br /><br />The case highlights the importance of considering echinococcosis in patients from endemic exposure areas, recognizing imaging clues such as the water lily sign, and coordinating care among infectious disease, surgery, and interventional radiology. It also emphasizes the risk of cyst rupture and anaphylaxis during intervention.

Asset Subtitle

Fatima Elwalid

Meta Tag

Author List Fatima Elwalid, Ishita Mehra, Sobia Syed, Syed R. Shah

Category Clinical Vignettes

Concept Hepatic Echinococcosis

Concept Clinical Presentation

Concept Imaging Finding

Concept Management

Concept Albendazole

Distinguished Non-Finalist

Presenter Organization NW Family Medicine Residency

Presenting Author Fatima Elwalid

Track Pediatric

Keywords

hepatic echinococcosis

hydatid cyst

Echinococcus IgG

water lily sign

protoscolices

albendazole

PAIR procedure

hepatic abscess differential

anaphylaxis risk

interventional radiology

Hepatic Echinococcosis

Clinical Presentation

Imaging Finding

Management

Albendazole