PMC7452423_01
Axial images of a non-enhanced CT scan of the abdomen showing a large 14.5 cm well defined hypodense cystic mass of spleen with internal thick dense septations.
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The chest x-ray showed no visible lung or mediastinal pathologies, however, an abnormal lucency in the left upper quadrant of his abdomen was noted. The CT confirmed the absence of thoracic pathologies, however, lower cuts through the upper abdomen showed splenomegaly, with a cystic mass at the lower pole of the spleen and an intraluminal floating membrane suggestive of a hydatid cyst (Fig. 1).
Longitudinal grey-scale images of the spleen which show a 14.2 cm anechoic splenic cyst that shows enhanced transmission through, and contains thick echogenic undulating septations.
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It showed an enlarged spleen, containing a thin-walled 14.2 cm x 9.9 cm septated cyst near the lower edge of the organ (Fig. 2).
(A) and (B) axial and coronal T2 weighted images (T2 single shot fast spin echo SSFSE) of 3 Tesla MRI that show a cystic lesion of the spleen. The cyst appears of high signal intensity with a hypointense rim (pericyst) and intraluminal septations mostly representing the detached membranes. Findings represent the "water lily sign". (C) Sagittal T1 3D gradient echo fat sat post gadolinium injection images of the splenic cyst during the portal venous phase that show no enhancement of the cyst wall or septa.
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The abdominal MRI showed an enlarged spleen containing a well-defined capsulated 14.5 cm cyst at the lower edge, with an intraluminal floating membrane representing the "Water Lilly" sign, compatible with a large hydatid cyst (Fig. 3).
Hydatid cyst membrane as seen during laparoscopy.
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Before closing, a flap of the omentum was moved to fill the residual cavity in the spleen (Fig. 4).
Laminated membranes of a hydatid cyst involving the spleen (H&E stain, enlarged x40).
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Later the same week the pathology report confirmed our diagnosis of a splenic hydatid cyst (Fig. 5).