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Echinococcus multilocularis Revisited

¹ Department of Radiology, Leopold-Franzens Medical School and University Hospital Innsbruck, Anichstr. 35, 6020 Innsbruck, Tyrol, Austria.
² Department of Gastroenterology, Leopold-Franzens Medical School and University Hospital Innsbruck, 6020 Innsbruck, Tyrol, Austria.

View larger version (134K): [in a new window]   Fig. 1A. —40-year-old woman with Echinococcus multilocularis infection of liver. Oblique sonogram obtained through right liver lobe shows several small hypoechoic areas with indistinct margins (large arrowheads) within echogenic region with indistinct border (small arrowheads). Pattern is caused by metacestodal vesicles within stroma.

View larger version (143K): [in a new window]   Fig. 1B. —40-year-old woman with Echinococcus multilocularis infection of liver. CT scan shows multiple ill-defined cystic lesions with different attenuation values scattered throughout liver. Lesions represent solitary and fused metacestodal vesicles and areas of liquefactive necrosis.

View larger version (143K): [in a new window]   Fig. 2A. —7-year-old girl with Echinococcus multilocularis infection of liver. Axial sonogram obtained through right liver lobe shows multiple echogenic nodules with irregular and indistinct margins in right lobe—the "hailstorm pattern"—representing parasitic stroma.

View larger version (142K): [in a new window]   Fig. 2B. —7-year-old girl with Echinococcus multilocularis infection of liver. CT scan shows multiple hypodense nonenhancing lesions with irregular and indistinct margins throughout liver.

View larger version (183K): [in a new window]   Fig. 3A. —41-year-old woman with metastatic Echinococcus multilocularis infection. Oblique sonogram obtained through right liver lobe shows lesion with central liquefactive necrosis. Large hypoechoic region with some internal echoes can be seen. Hyperechoic border (arrowheads) of lesion is irregular and indistinct.

View larger version (124K): [in a new window]   Fig. 3B. —41-year-old woman with metastatic Echinococcus multilocularis infection. CT scan obtained at level of liver reveals large heterogeneous lesion in liver with irregular and indistinct margins showing same morphology as lesion in spleen. Small peritoneal nodules with punctate calcifications (arrowheads) can be recognized.

View larger version (135K): [in a new window]   Fig. 4. —68-year-old woman with Echinococcus multilocularis infection of liver. CT scan reveals heterogeneous, abscesslike lesion with irregular contours and indistinct margins. There is no contrast enhancement. No calcifications are visible.

View larger version (169K): [in a new window]   Fig. 5A. —38-year-old woman with Echinococcus multilocularis infection of liver in advanced stages. CT scan shows large hypodense mass with central necrosis and peripheral calcifications that are coarse, irregular, and rimlike.

View larger version (146K): [in a new window]   Fig. 5B. —38-year-old woman with Echinococcus multilocularis infection of liver in advanced stages. Axial T2-weighted MR image (turbo spin-echo; TR/TE, 5000/165) reveals central necrosis with high signal intensity. Peripheral calcifications show low signal intensity (arrows).

View larger version (150K): [in a new window]   Fig. 5C. —38-year-old woman with Echinococcus multilocularis infection of liver in advanced stages. Axial CT scan obtained 10 years later than A shows air—fluid level and abscess formation within parasitic lesion. In this patient, abscess formation was sudden.

View larger version (132K): [in a new window]   Fig. 6. —66-old-man with Echinococcus multilocularis infection of liver. CT scan reveals large calcification with irregular margins in right liver lobe, representing nonvital final stage of disease.

View larger version (147K): [in a new window]   Fig. 7A. —40-year-old man with Echinococcus multilocularis infection of liver. Axial T1-weighted MR image (turbo spin-echo; TR/TE, 8/4) shows dilated bile ducts (arrows) in left liver lobe and lobar atrophy. Multiple hypointense lesions scattered throughout liver represent calcifications (arrowheads).

View larger version (101K): [in a new window]   Fig. 7B. —40-year-old man with Echinococcus multilocularis infection of liver. T2-weighted MR image obtained using rapid acquisition with relaxation enhancement sequence reveals dilatation of bile ducts (arrows) in left liver lobe.

View larger version (182K): [in a new window]   Fig. 8. —73-year-old man with Echinococcus multilocularis infection of liver. Oblique sonogram obtained through liver hilum shows infiltration of portal vein by parasitic tissue (arrow).

View larger version (146K): [in a new window]   Fig. 9. —50-year-old woman with Echinococcus multilocularis infection of liver and retroperitoneum. CT scan reveals infiltration of liver hilum and retroperitoneum by parasitic tissue. Note infiltration of left portal vein (arrows) and inferior vena cava (large arrowhead) resulting in obstruction of these vessels. Small calcifications (small arrowheads) can be seen.

View larger version (166K): [in a new window]   Fig. 10. —49-year-old man with Echinococcus multilocularis infection of liver. CT scan shows right lobar atrophy caused by invasion of hilum by parasitic tissue. Scattered areas with calcifications, dilated bile ducts, and areas of liquefactive necrosis can be seen.

View larger version (102K): [in a new window]   Fig. 11. —46-year-old man with Echinococcus multilocularis infection of lungs. CT scan with mediastinal window reveals irregular, ill-defined mass that is located peripherally and shows contact with visceral pleura. Within lesion, small cysts (arrows) can be seen. Different densities are visible; margins are indistinct. Pleural effusion and reactive pleural thickening are also evident.

View larger version (132K): [in a new window]   Fig. 12A. —60-year-old man with metastatic Echinococcus multilocularis disease. CT scan obtained at level of chest shows parasitic mass in lower median mediastinum caused by direct penetration of hepatic lesion through right hemidiaphragm (arrowheads). As result of infiltration and obstruction of inferior vena cava by parasitic tissue, venous blood flow is collateralized via azygos and hemiazygos veins. These veins thus appear markedly enlarged (arrows).

View larger version (123K): [in a new window]   Fig. 12C. —60-year-old man with metastatic Echinococcus multilocularis disease. CT scan obtained at level of lower abdomen shows infiltration of third lumbar vertebra (arrowheads) by retroperitoneal lesion.

View larger version (125K): [in a new window]   Fig. 13. —54-year-old woman with metastatic Echinococcus multilocularis disease. CT scan shows involvement of liver (straight arrows), spleen (arrowheads), left adrenal gland (curved arrow), and soft tissue (open arrows). In contrast to lesions within abdominal organs, marked contrast enhancement is seen within soft-tissue lesions.

View larger version (143K): [in a new window]   Fig. 3C. —41-year-old woman with metastatic Echinococcus multilocularis infection. CT scan obtained at level of lower abdomen shows diffuse cystic infiltration of omentum by parasitic tissue resulting in thick, sheetlike mass containing multiple small cysts (arrows). There are small curvilinear calcifications in some cysts (arrowheads).

View larger version (169K): [in a new window]   Fig. 3D. —41-year-old woman with metastatic Echinococcus multilocularis infection. CT scan obtained at level of pelvis shows parasitic tissue extending into pelvis and encasing uterus and adnexa. Small calcifications (arrowheads) can be seen.

View larger version (130K): [in a new window]   Fig. 14. —35-year-old man with metastatic Echinococcus multilocularis disease. CT scan obtained at level of kidneys shows large retroperitoneal parasitic lesion infiltrating right kidney, inferior vena cava, and iliopsoas muscle. No contrast enhancement is visible at periphery of lesion calcifications (small arrowheads). Patient had previously undergone hemihepatectomy of right liver lobe for E. multilocularis infection. Bile ducts in left liver lobe are dilated (large arrowheads).

View larger version (156K): [in a new window]   Fig. 12B. —60-year-old man with metastatic Echinococcus multilocularis disease. CT scan obtained at level of kidneys reveals large retroperitoneal lesion with central necrosis. Lesion has infiltrated and obstructed inferior vena cava (arrowhead), enclosed aorta, and infiltrated right lower kidney (arrow).

View larger version (154K): [in a new window]   Fig. 12D. —60-year-old man with metastatic Echinococcus multilocularis disease. CT scan obtained at level of pelvis reveals echinococcal tissue located distal to retroperitoneal lesion (B and C) and growing within inferior vena cava, using vein as sheath. Note small central punctate calcification (arrowhead).

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