Echinococo

za

Foxes may be a reservoir of zoonotic agents

such as rabies virus and the parasite
Echinococcus multilocularis.

Hydatid disease.
Cyst revealed on CT scan (left) and at
craniotomy (right).

Echinococcosis.
Cerebral angiography showing displacement of
vessels by a large mass in the frontal region.

Hydatid disease. Surgical specimen swowing

multiple thin-walled, fluid/ filled cysts.

Echinococcosis
. Cyst
removed from
patient.

A large, thick-walled unilocular cyst is

characteristic of infestation of Echinococcus
granulosus.

Hidatid disease. Chest radiographs showing

well-defined round lesion in middle zone of
right lung.

Hydatid disease. Chest radiograph snowing

partially evacueted cyst (arrowed) in the
middle yone of the right lung.

Echinococcus cyst in right lung of an

adult male.

Fluid-filled echinococcus cyst in the lungs of an

adolescent male.

Hydatid disease. CT scan of the thorax

showing hydatid cyst of right lung.

Gross pathology photograph of the membrane and

hydatid daughter cysts excised from a human lung.
Hydatid disease is a parasitic infestation by a
tapeworm of the genus Echinococcus. Endemic areas
usually involve third world countries. The liver is the
most common organ involved, followed by the lungs .

Echinococcus abscess of liver in an adult, the

most common site of abscess formation.

Cysts are fused in the liver parenchyma. E.

multilocularis is endemic in Hokkaido.

Echinococcosis. An echinococcal cyst showing daughter cyst,

rescted from the liver (left), and histological section showing
the layers of an hydatid cyst (right).

Gross crosssection of
liver with a
hydatid
(echinococc
al) cyst.
The cyst
consists of
a large
unilocular
cyst
with
daughter
cysts.

Echinococcus cyst in the right lobe of the liver

in a 27-year-old male. Note the striking
elevation of the right hemidiaphragm.

Abdominal radiograph showing hepatic mass

(echinococcus cyst).

Echinococcosis. Abdominal
radiograph showing a calcified
hydatid cyst in the liver.

Liver cyst due to echinococcus granulosus infection.

Computed tomography scan demonstrates a large
multilocular cystic mass in the liver with distinctive internal
daughter cysts characteristic of Echinococcus infection.
Approximately 40% of echinococcal (hydatid) cysts will
demonstrate some crescentic or curvilinear calcification.

Hydatid disease. Computerized tomogram

showing ruptured cyst with internal
membrane floating within cavity.

Echinococcosis.
Ultrasound scan showing multioculated cyst in liver.

Echinococcosis.
CT scan showing large multioculated cyst in left lobe of liver.

Echinococcosis.
Endoscopic
retrograde
cholangiopancreatography
showing
intrahepatic
hydatid cystic
space draining
into
the biliary tree.

Echinococcus granulosus. Daughter cysts

within a large unilocular cyst, surgically
removed from a Peruvian Nisei. The patient
died of anaphylactic shock during surgery.
Leakage of the cyst fluid (hydatid fluid) should
be avoided.

Echinococcosis.
(a) scolices of E. granulosus
(b) hooklet at a higher magnification.

Protoscolex in the daughter cyst (stereo

microscopic observation). Hooklets on the
rostellum are characteristic. In old cysts,
isolated protoscolexes accumulate as hydatid
sand.

"Hydatid sand". Fluid aspirated from a

hydatid cyst will shows multiple protoscolices
(size approximately 100 m), each of which
has typical hooklets.

Echinococcus granulosus. Scolices from a

hydatid cyst showing both invaginated and
evaginated hooklets and suckers.

Scolex of
Echinococcu
s
granulosus.
The scolex is
invaginated
and has a
double row
of hooklets.

Echinococcus granulosus. Adult

tapeworm.

Echinococcosis. Cyst inliver showing laminated, non nuclear

layer, nucleated germinal layer with many brood capsules
attached, and multiple scolices within the cyst cavity.

Beautiful lamellated structure is

demonstrated in the cyst wall by PAS stain.

Section
of a hydatid
(echinococca
l) cyst wall
displaying a
laminated
membrane
and germinal
layer.

Hooklet or
scimitar
from
Echinococcus
granulosus
showing acidfast positivity.

Echinococcosis.
Fluid from cyst
viewed under
polarized light
showing hook
of hydatid.