Snapshot quiz 15/3

Published: 03/09/2015

Authors: Karavokyros I and Moris D

A 75-year-old man presented with a 3-day history of epigastric pain. The diagnosis of rupture of hydatid cyst was highly suspected on CT (a). Note the red arrows showing free peritoneal fluid indicating cyst rupture. He had urgent laparotomy and cyst removal (b). The water-lily sign on CT is seen when there is detachment of the endocyst membrane, which results in floating membranes within the pericyst that mimic the appearance of a water lily. Although rarely seen, it is pathognomonic for Echinococcus. Urgent surgery for ruptured hydatid cyst affects postoperative morbidity and mortality favourably.