대한흉부영상의학회 Weekly Chest Cases

Case No : 339 Date 2004-04-24

Courtesy of Santiago E. Rossi, M.D. / Centro de Diagnostico Dr Enrique Rossi
Age/Sex 49 / M
Chief ComplaintHistory of cough and hemoptysis for 10 days

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Diagnosis With Brief Discussion

Diagnosis: Echincoccus Granulosus (Hydatid disease)
Radiologic Findings: Chest radiograph shows bilateral round-lobulated nodules.
Chest CT shows multiple, bilateral cystic nodules/masses. Coned-down CT (upper right lobule) shows a well-defined lobulated, homogenous (water density) mass. Coned- down CT shows two nodules (cysts) with a thin crescent of air around the periphery of the cyst (meniscus or crescent sign). Note also small air cavities within the cysts.
Brief Review: Echinococcus granulosus is the most common cause of human hydatid disease. The pastoral form occurs predominantly in Middle East, South Amreica and Russia. The intermediate hosts are sheep, cows, horses and pigs and the definite hosts are dogs.

The radiologic manifestations consist of well marginated, spherical, or oval masses 1-20 cm in diameter. Mulstiple cysts are seen in 20 to 30% of patients. Bilateral lesions are seen in up to 20-50% of patients. The “meniscus” sign reflects the presence of air between the pericyst and exocyst, due to communication between the cyst and the airways. The “Cumbo” sign is defined as the presence of meniscus sign and air-fluid level within the cyst. After a cyst has ruptured into the bronchial tree, the collapsed endocyst-exocyst may be contrasted with surrounding air resulting in the “water lilly”.
References: 1. Sadriech M, Dutz W, Navabpoor MS. Review of 150 cases of hydatid cyst of the lung. Chest 1967;52:662-666.
2. Beggs I. The radiology of hydatid disease. Am J Roentgenol 1985;145:639-648.
3. Muller NL, Fraser RS, Soo Lee K, Johkoh T. Diseases of the Lung. Radiologic and pathologic correlations. 2003 Lippincott Williams & Wilkins.
Keywords: Lung, Infection, Parasitic infection,

No. of Applicants : 34

▶ Correct Answer : 14/34, 41.2%

- CH Lyon sud, France Xavier Riviere
- Ewha Woman's University Hospital, Korea Yoo Kyoung Kim
- Eulji Hospital, Korea Jeong Joo Woo
- Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- HEGP, Paris Rached Triki
- Maimonides Medical Center, N.Y., USA Naomi Twersky
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- National Taiwan University Hospital, Taiwan Tan Che Kim
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Royal Melbourne Hospital, Melbourne, Australia Stefan Heinze
- Royal Melbourne Hospital, Melbourne, Australia Ruth Lim
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 3/34, 8.8%

- Annecy Hospital, France Gilles Genin
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- CIM Saint Dizier, France JC Leclerc

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 339 Date 2004-04-24

Discussion

No. of Applicants : 34