History: A 19-year-old Turkish woman was admitted to the emergency room because of the worsening recurrent pain in the right abdomen radiating to the right shoulder and right flank.
Investigations: Ultrasound examination showed a polycystic mass in the right lobe of the liver surrounded by a capsule. A contrast-enhanced ultrasound examination was done. It revealed, starting in the arterial phase, marginal enhancement near the capsule of the liver lesion.
Treatment and course: The suspected diagnosis of a hydatid liver disease caused by Echinococcus granulosus was confirmed by serology. The patient was treated with oral albendazole (400 mg, twice daily) for eight weeks. Follow-up ultrasound examinations showed significantly reduced "collapsing" cyst membranes. A hydatid cyst weighing 130 g and 8 cm in diameter was resected by open laparatomy nine weeks after diagnosis. Albendazole treatment was continued for six months and well tolerated by the patient. One year after surgical treatment the serology was negative.
Conclusions: Ultrasound examination is the method of choice for the initial diagnosis and follow-up of hepatic echinococcosis. Serology is not always reliable. The treatment depends on the WHO stage of the disease and individual factors.