Case report ： A case misdiagnosed as cystic echinococcosis in alveolar echinococcosis

Abstract Background Echinococcosis is one of the most common parasitic diseases among humans and animals worldwide, with the most prominent in the northwest region of China. According to different types of infected larvae, it can be divided into cystic echinococcosis and alveolar echinococcosis. Both types of infected organs are most common in the liver. Here we report a 49 years old female patient with hepatic cystic echinococcosis who was initially misdiagnosed as hepatic cystic echinococcosis (CE1) due to her imaging findings being very similar to those of cystic echinococcosis. After further examination and literature review, we were ultimately diagnosed with hepatic alveolar echinococcosis (P4), which was confirmed by surgery and postoperative pathology. In the article, we use MRI and MRCP as recommendations for distinguishing the two, which can efficiently help us distinguish them and avoid misdiagnosis. Presentation: We report a 49 year old female patient residing in an area with a high incidence of hydatid disease. She was admitted with the chief complaint of "persistent swelling and pain in the upper right abdomen for more than half a month". Prior to admission, the abdominal CT result diagnosed her with hepatic cystic echinococcosis CE1 type, which was a huge liver mass of 13.5cm * 13cm * 14cm. After admission, a comprehensive MRI and MRCP imaging examination was performed, and the results were different from CT. The diagnosis was P4 stage cystic cystic echinococcosis in the right lobe of the liver. Through literature review and general practice discussions, we ultimately diagnosed with P4 type of cystic cystic echinococcosis in the right lobe of the liver, and actively prepared for surgery. Due to the large size of the patient's liver lesion, the risk of surgery was assessed to be high. We first performed percutaneous liver puncture under ultrasound to drain the cystic fluid of the lesion. After the lesion collapsed, we finally performed a right hemihepatectomy. The surgery went smoothly and the patient recovered well, and was discharged as scheduled. After intraoperative and postoperative pathological diagnosis, it was confirmed that our diagnosis and treatment were correct and misdiagnosis was avoided. Conclusion when faced with difficult to distinguish AE and CE, MRI and MRCP may be the best choices to solve the problem, as they can effectively avoid misdiagnosis.