case_images: PMC11342428_01
case_images: (a) Two round lesions, left of 3.38 cm, right of 3.71 cm. (b) Two lesions with liquid and solid content. (c) Left lesion with water lily sign.
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case_images: On clinical evaluation, physical findings were negative, but with the history and symptoms, her physician requested radiological studies revealing two lesions on both lungs (Figure 1(a)). A computed tomography (CT) showed the presence of round cystic lesions, with defined contours in the lower pulmonary lobes and a cystic image in the liver; one image in the right lung was compatible with "the water lily sign" (Figure 1(b) and (c)).
case_images: (a) Two solid lesions. (b) Increase in size of the lesions compared to previous studies. (c) Round lesion located in the anterior wall of the liver.
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case_images: Treatment consisted of ABZ for 3 months with no clinical improvement, so a second CT was obtained and the two known pulmonary cystic lesions increased in size and progressed to solid lesions (Figure 2(a) and (b)), the one in the right lung was 3.5 cm and one in the left lung was 4.2 cm, the lesion in the liver was unchanged (Figure 2(c)).
case_images: (a) Round lesion located in the IV segment of the liver. (b) Lesion completely resected with free margins.
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case_images: A laparoscopy was continued to resect the liver lesion, and a cystic lesion of 3 x 3 cm (Figure 3(a)) toward segment IV with a thick capsule was found. The lesion was completely resected and sent to pathology (Figure 3(b)).
case_images: (a) Protoscolices. (b) Hooks of echinococcal scolex. HE 40x.
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case_images: Pathology studies revealed the presence of cystic echinococcosis in both lungs and liver, with evidence of protoscolices and refractory hooks of echinococcal scolex, highlighted by the Grocott technique; Ziehl-Neelsen and periodic acid-Schiff (PAS) were found (Figure 4(a) and (b)).
case_images: (a) No lesions, presence of surgical changes. (b) Surgical changes with no signs of recurrence.
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case_images: She continues with antiparasitic treatment with ABZ to complete 6 months and periodic follow-ups by her primary doctors who sent a control CT showing no recurrence of the cysts (Figure 5(a) and (b)).
case_images: PMC11342428_02
case_images: Round lesion in the lower lobe of the right lung.
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case_images: On the first evaluation with her physician, the patient had ambiguous clinical findings so it was recommended to do laboratory test, and in a chest X-ray one image in the right lower lobe of the lung was found (Figure 6).
case_images: Lesion with air-fluid level in the lower lobe of the right lung.
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case_images: The second physician made more in-depth investigations with a CT scan that revealed a round cystic lesion with an air-fluid level in the lower lobe of the right lung compatible with the lesion seen on the chest X-ray (Figure 7).
case_images: Echinococcal scolex and hooks. HE 40x.
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case_images: Pathological studies reported the presence of hooks in the right lung lesion, with the presence of echinococcal scolex (Figure 8).