Daughter cyst sign in isolated peritoneal hydatid disease.

Abstract

A 35-year-old patient with no pertinent past medical history presented with recurrent abdominal pain of three months duration. There were no associated symptoms. The abdominal ultrasound showed a homogenous, well-circumscribed cystic mass in the pelvic cavity. The immunology of cystic echinococcosis was negative. Abdomen and pelvis CT scan revealed a pelvic cyst measuring six centimeters in diameter. The cyst wall appeared bumpy and communicated with a second adjacent small rounded lesion corresponding to a daughter cyst (figure). The rest of the imaging findings were unremarkable. The diagnosis of isolated peritoneal hydatid cyst was made. The patient underwent a cystectomy with uneventful postoperative course. Daughter cysts formation is common in the parasite evolution. They are usually endogenous [1]. In some cases, the daughter cysts are progressively pushed outwards and develop as exogenous extensions [2]. The daughter cyst sign is pathognomonic for hydatid disease and is usually seen in liver hydatid cysts. Daughter cysts are associated with a high risk of recurrence after surgery. Radical excision is to be preferred in these cases [3].