Abstract
The ultrasonographic examination revealed multiple large cysts in both lobes of the liver involving segments III, IV, VI, and VII. The cysts were in stage I of cystic echinococcosis (CE I) as per the classification proposed by the World Health Organization (WHO) Informal Working Group (1). The largest cyst measured about 7 cm by 5 cm in segment VI with no perihepatic collection and/or ascites. The patient’s serum was positive for anti-Echinococcus IgG by enzyme-linked immunosorbent assay using a commercial kit (Novalisa Echinococcus IgG; NovaTec, Germany). She was started on 400 mg of albendazole twice daily for 14 days, following which she underwent puncture, aspiration, injection of 20% hypertonic saline, and reaspiration (PAIR) for the cysts present in segment III and segment VI. Microscopic examination of the aspirated cyst fluid (Fig. 1) revealed two classical protoscolices with armed rostellum (arrowhead B) and two rows of refractile dagger-shaped hooklets (arrowhead A). A few remnant parts of germinal layer were seen. These findings were suggestive of protoscolices of Echinococcus granulosus sensu lato complex (2, 3).
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