Question:
A 15-year-old boy presents with progressive abdominal distension and weight loss. Imaging reveals a cystic lesion in the liver, and following sudden severe abdominal pain, free peritoneal fluid is noted. Which is the most likely diagnosis?
A 15-year-old boy presents with progressive abdominal distension and weight loss. Imaging reveals a cystic lesion in the liver, and following sudden severe abdominal pain, free peritoneal fluid is noted. Which is the most likely diagnosis?
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Hydatid Cyst Rupture: Acute abdominal pain + Free peritoneal fluid + Urticaria Anaphylaxis. Medical management: Albendazole prophylaxis + Emergent resuscitation and surgical/PAIR management.
Updated On: Sep 3, 2026
- Hepatoblastoma
- Hepatocellular carcinoma
- Hydatid cyst
- Liver cirrhosis
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The Correct Option is C
Solution and Explanation
Concept:
Cystic echinococcosis (hydatid disease) is a zoonotic parasitic infection caused by the larval metacestode stage of the dog tapeworm, Echinococcus granulosus.
The liver is the most common organ involved ($>70\%$ of cases). Hydatid cysts can remain asymptomatic for years until growth produces mass effect or acute complications like cyst rupture occur.
Explanation:
• In humans (accidental intermediate hosts), ingested oncospheres penetrate the intestinal mucosa, enter the portal circulation, and develop into slow-growing, fluid-filled unilocular or multilocular hydatid cysts with inner germinal layers and surrounding daughter cysts.
• A well-recognized life-threatening emergency in cystic echinococcosis is intraperitoneal rupture of the hydatid cyst, which can occur spontaneously due to high intracystic pressure or secondary to blunt abdominal trauma.
• Rupture presents with sudden-onset acute severe abdominal pain, signs of peritonitis, free fluid (hydatid fluid and daughter cysts) in the peritoneal cavity on ultrasonography/CT, and a high risk of life-threatening anaphylactic shock due to the release of highly antigenic cyst contents.
• Hepatoblastoma and hepatocellular carcinoma present as solid, vascular hepatic masses rather than clear unilocular/multilocular fluid-filled cysts with rupture causing free fluid.
• Liver cirrhosis presents with diffuse parenchymal nodularity, portal hypertension, and ascites without an isolated cystic mass.
Final Answer:
The clinical course of an expanding hepatic cyst suffering acute rupture with severe pain and free peritoneal fluid is indicative of a ruptured Hydatid Cyst.
Cystic echinococcosis (hydatid disease) is a zoonotic parasitic infection caused by the larval metacestode stage of the dog tapeworm, Echinococcus granulosus.
The liver is the most common organ involved ($>70\%$ of cases). Hydatid cysts can remain asymptomatic for years until growth produces mass effect or acute complications like cyst rupture occur.
Explanation:
• In humans (accidental intermediate hosts), ingested oncospheres penetrate the intestinal mucosa, enter the portal circulation, and develop into slow-growing, fluid-filled unilocular or multilocular hydatid cysts with inner germinal layers and surrounding daughter cysts.
• A well-recognized life-threatening emergency in cystic echinococcosis is intraperitoneal rupture of the hydatid cyst, which can occur spontaneously due to high intracystic pressure or secondary to blunt abdominal trauma.
• Rupture presents with sudden-onset acute severe abdominal pain, signs of peritonitis, free fluid (hydatid fluid and daughter cysts) in the peritoneal cavity on ultrasonography/CT, and a high risk of life-threatening anaphylactic shock due to the release of highly antigenic cyst contents.
• Hepatoblastoma and hepatocellular carcinoma present as solid, vascular hepatic masses rather than clear unilocular/multilocular fluid-filled cysts with rupture causing free fluid.
• Liver cirrhosis presents with diffuse parenchymal nodularity, portal hypertension, and ascites without an isolated cystic mass.
Final Answer:
The clinical course of an expanding hepatic cyst suffering acute rupture with severe pain and free peritoneal fluid is indicative of a ruptured Hydatid Cyst.
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