A Shocking Cystory

A39-year-old woman from the south highland of Peru presented with abdominal distention, 10-kg weight gain, and intense stabbing pain in right upper quadrant of the abdomen. On physical examination, she had abdominal dullness and distention. She had a history of a liver cyst diagnosed by ultrasound 14 years ago. Three years ago a second ultrasound showed 3 cysts inside the first one. She did not receive any treatment before this hospitalization. The patient used to raise dogs and livestock (sheep and cattle) in her rural house when she was a child. The current ultrasound showed large cysts in liver and spleen that were confirmed by an abdominal computed tomography (CT) scan that revealed that both cysts contained hundreds of smaller cysts inside. Laboratory results showed a positive enzyme-linked immunosorbent assay (immunoglobulin G) for hydatid cyst. Laparotomy was performed, and the liver cyst was removed as well as the entire spleen. In this article, we present images that show the huge amount of cysts. For example, we have a coronal view of the abdominal CT scan (A) showing multiple cysts in the liver and spleen, extended throughout the abdomen. The lateral view of the patient’s abdominal CT scan (B) shows the extension of the cysts are from the liver to the pelvis. The transverse view of the CT scan shows multiple cysts on the spleen and liver (C). During the surgery, the surgeon extracted multiple smaller cysts from the liver and spleen (D). Finally, before the surgery, the patient had a big belly, almost like a pregnant woman in her third trimester (E)